Anales de la RANM

197 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 CÁNCER DE PENE EN UN HOSPITAL DE TERCER NIVEL DE LA CIUDAD DE MÉXICO Angulo Lozano JC, et al. An RANM. 2022;139(02): 196 - 201 Penile cancer has an incidence of 1/100,000 males, becoming a rare malignancy in the world. (1) Developing countries have a higher incidence than non-developing ones, having 6% of all malignant neoplasms. (2) Mexico has an incidence rate of 0.91 per 100,000 males and 0.31% of the total malignant neoplasms, resulting in a mortality rate of 0.2 per 100,000, representing 0.17% of cancer deaths (3,4). Most male patients with penile cancer are older, with a mean age on the sixth decade. The diagnosis is between 50-70 years old (5,6). Most penile carcinomas are of squamous (SCC) origin (95%). (2). The incidence diverges according to some practices, such as phimosis, sexual partners, HPV infection, circumcision practice, tobacco exposure, and other factors (7,8). Cigarette smokers have 3 to 4.5 times fold-risk of developing penile cancer (9,10). Recently, penile invasive SCC and its variants, as well as precursor lesions, are divided into two major categories: related and non-related to HPV (11). Basaloid, warty, and warty basaloid carcinomas are included in the HPV-related group, while typical, verrucous, papillary, sarcomatoid, pseudohyper- plastic, and cuniculatum carcinomas are included in the other category. Small to intermediate basophilic, undifferentiated, or basaloid cells make up the majority of HPV-related cancers, whereas highly keratinized, differentiated squamous cells make up the majority of HPV-negative tumors (11,12,13) Penile carcinoma typically starts as a tiny lesion that spreads throughout the entire glans, shaft, and corpora. The lesion can be papillary and exophytic or flat and ulcerative, and if left untreated, it can lead to penile auto-amputation. Although the development rates of papillary and ulcerative lesions are similar, the flat, ulcerative tumor has a higher risk of nodal metastasis and has a 5-year survival rate. (14) Although most lesions are limited to either the foreskin or the glans, a subset of cases shows the involvement of multiple compartments, in some cases extending into the glans, coronal sulcus, and foreskin's inner mucosa. Multifocal lesions are found in approximately 15% of cases (15). Before starting any treatment, a microscopic analysis of a biopsy specimen is required to confirm the diagnosis of penile cancer, as well as to determine the degree of invasion, the existence of vascular invasion, and the histologic grade of the lesion. (16) Penile preservation techniques have been more popular in recent years as it has become clear that this sort of surgery for a primary cancer is linked to improved functional outcomes and psychological well-being (17). Penile cancer involving the redundant preputial and penile skin can be adequately treated with circumcision. Because glansectomy can be used to treat penile cancer involving the spongy erectile tissue of the glans, excision can save the corpora cavernosa, and reconstruction is confined to a redefinition or covering surgery of the distal corporal bodies. Often, just grafting the tips of the corporal bodies provides an excellent function as well as cosmetic result (18). Minimally invasive treatments such as imiquimod or 5-fluorouracil (5-FU) topical chemotherapy, laser therapy, or brachytherapy can be used to treat precancerous alterations or early- stage malignancies (19,20). Patients with untreated inguinal metastases rarely live longer than two years. After surgical care, patients with stage I or II malignancies that are still restricted to the penis at the time of diagnosis had a 5-year survival rate of roughly 85%. The 5-year survival rate for stage III and IV malignancies is roughly 59%. The 5-year survival rate for cancer that has spread to other regions of the body is 11% (16). Circumcision, male vaccination of HPV, early treatment of phimosis, smoking cessation, and hygiene practices are some of the potential techniques for preventing penile cancer. Some of these measures would necessitate a thorough cost-benefit analysis as well as significant changes in global health policy (21). Because of the disease's rarity, data collection and standardization in clinical practice have been limited. This is a descriptive cross-sectional study. The participants in the research (n=93) are hispanic, adult male patients and residents of Mexico City Metropolitan area with penile cancer diagnosed by a pathology report of Mexico General Hospital “Dr. Eduardo Liceaga”, a tertiary care hospital in Mexico City. The inclusion criteria considered for this study were: male adults between 20-90 years at the date of diagnosis, diagnosis of penile cancer with a pathological report and treated in Mexico General Hospital “Eduardo Liceaga” between 2013-2019 with a 24 month follow-up. Exclusion criteria was loss of follow up, pathological report of other dysplastic diseases of the penis and age. 168 medical files were examined and 75 were excluded because of loss of follow up or pathology report inconsistent with penile cancer. The variables of interest analyzed in this study are: Age, smoking status, HPV status, pathology report of biopsied specimen, presence of vascular invasion, curative treatment used, and survival status at 24 months after diagnosis. The mean age of the group of study (n=93) was 57.87 (SD ± 12.93). 52 (55.9%) were active smokers and 41 (44.1%) never smoked. 93 (100%) were uncircumcised. 77 (82.1%) patients were HPV (-) by pathology report and 16 (17.2%) were HPV (+). Squamous Cell Carcinoma (SCC) was the predomi- nant type of cancer in our group with 80 (86%) of the cases with a pathology report of SCC and 13 (14%) reported as other variants of penis carcinoma. 76 (81.7%) patients did not have vascular invasion and 17 (18.3%) had vascular invasion. INTRODUC TION MATERIAL AND METHODS RESULTS