Objectives
  • To appreciate the role of human papilloma virus (HPV) and ethnic background as well as hygienic standards in the aetiology of penile cancers

  • To understand the importance of staging and, in particular, of lymph node staging for prognosis and for treatment

  • To understand the potentially curative role of surgery and radiation treatment

  • To understand the role of combination chemotherapy for metastatic disease

Awareness
  • Awareness that squamous cell carcinoma (SCC) accounts for more than 95% of cases of penile cancer and that currently no molecular biomarkers have shown to be useful in clinical practice

  • Awareness that, at the time of diagnosis, almost half of palpable inguinal nodes are enlarged due to inflammatory changes

  • Appreciation that accurate staging is important for prognosis and adequate local (more or less radical) or combined treatment

  • Awareness of the multimodal treatment approaches that include different surgical tools and radiotherapy

  • Awareness that, due to the rarity of the disease, level 1 evidence for systemic treatment approaches is lacking and that chemotherapy, mostly cisplatin-based, has a palliative therapeutic role for metastatic disease

Knowledge
  • Knowledge about the different approaches for staging and in particular of lymph node staging

  • Knowledge that early detection of lymph node metastases by dynamic sentinel node biopsy (DSNB) and subsequent resection in clinically node negative T2–3 penile cancer improves survival

  • Knowledge that if no DSNB is available, ultrasound-guided fine needle aspiration (FNA) cytology (FNAC) biopsy of visualised nodes can be used for staging

  • Knowledge about stage-dependent local treatments like penile-preserving techniques, including topical therapy for low-disease stages, possible wide local excision plus reconstructive surgery, new laser therapy approaches, radiotherapy delivered as external beam radiation therapy (EBRT) or brachytherapy with interstitial implants, and partial surgery approaches or penectomy for high-tumour stages

  • Knowledge that, for non-palpable, enlarged and biopsy- or DSNB-positive lymph nodes, lymphadenectomy is recommended

  • Knowledge that, for unilateral or bilateral palpable inguinal nodes, FNA of the lymph node is standard diagnostic procedure

  • Knowledge that, when pelvic lymph nodes are enlarged, systemic chemotherapy or radiotherapy with concurrent chemotherapy are reasonable treatment options

  • Understanding that patients with non-fixed nodes can be considered for inguinal node dissection with the option to use a skin flap to cover the defect

  • Understanding that patients with fixed nodes should be considered for neoadjuvant chemo-radiotherapy and responders can receive consolidation surgery

  • Understanding that patients with disease progression or unresectable lymph nodes should be considered for additional systemic chemotherapy or local-field radiotherapy

  • Knowledge that, for metastatic penile cancer, treatment options include systemic chemotherapy or radiotherapy or radiotherapy with concurrent chemotherapy

Skills
  • Ability to discuss the different approaches for staging and, in particular, lymph node staging for penile cancer

  • Ability to council patients and discuss in multidisciplinary tumour boards the management of enlarged pelvic lymph nodes with systemic chemotherapy or radiotherapy with concurrent chemotherapy

  • Ability to discuss side effects of surgery and, in particular, lymph node dissection and chemoradiation of pelvic and inguinal lymph nodes

  • Ability to discuss the treatment of patients with fixed nodes with neoadjuvant chemoradiotherapy and potential consolidation surgery

  • Ability to council patients with metastatic penile cancer about systemic chemotherapy or radiotherapy or radiotherapy with concurrent chemotherapy and explain side effects of chemotherapy