The most common cause of death in carcinoma penis?
Ans. d (Erosion of femoral vessels) (Ref. Bailey and Love 26th/pg. 1375)CARCINOMA OF PENISAetiology# Circumcision6 soon after birth confers almost complete immunity against carcinoma of the penis.# Later circumcision does not seem to have the same effect and muslims circumcised between the ages of 4 and 9 years are still liable to the disease.# Chronic balanoposthitis in known to be a contributory factor.6# Definite precarcinomatous states:- Leucoplakia of the glans is similar to the condition seen on the tongue;- Longstanding genital warts may rarely be the site of malignant change;- Paget's disease of the penis.Pathology# Carcinoma of the penis may be flat and infiltrating or papillary.# The former often starts as leucoplakia and the latter results from an existing papilloma.# The earliest lymphatic spread is to the inguinal and then to the iliac nodes.6# Once the growth breaches the partial barrier formed by the fascial sheath of the corpora cavernosa it spreads rapidly and iliac lymph node involvement is common.6# Distant metastatic deposits are infrequent.Clinical Features# Forty % of patients are under 40 years of age.# There is little or no pain.# Sixty % have inguinal lymph node enlargement when they present but in half this is reactive enlargement due to sepsis.# Later the inguinal nodes erode the skin of the groin and the death of the patient may be due to involvement of the femoral or external iliac artery with TORRENTIAL HEMORRHAGE.6Rx# Radiotherapy is effective (60-70 % survival at 5years) if the growth is small.# Surgery is needed for large anaplastic growths, if there is infiltration of the shaft and when radiotherapy fails.0# Partial amputation is used for distal growths when adequate clearance of the tumor is possible.# When an advanced, infiltrating or anaplastic lesion is present, total amputation is necessary.# Treatment of associated enlarged inguinal lymph nodes should usually be delayed until at least 3 weeks after local treatment to the primary lesion.# If surgery to the nodes is impossible, radiotherapy may cause a worthwhile temporary regression.Also know:Buschke-Lowenstein tumor is uncommon, verrucous carcinoma. It is locally destructive and invasive, but appears not to spread to lymph nodes or to metastasise. Treatment is by surgical excision.Paget's disease of the penis (syn. erythroplasia of Queyrat)0 is 'a persistent rawness of the glans like a long-standing balanitis followed by cancer of the substance of the penis' (Sir James Pager). Treatment is by circumcision, observation and excision if the lesion does not resolve.
Uremia
Urinary sepsis
Lung metastases
Erosion of femoral vessels
Urethra & Penis