Penile Cancer Staging Systems

The Jackson staging system was initially introduced in 1966 and divided patients into four groups based on the operability and nodal metastases.

Table A.1 Jackson classification 1966

Confined to glans or prepuce

Invasion into shaft or corpora

Operable inguinal lymph node metastasis

Tumor invades adjacent structures; inoperable inguinal lymph node metastasis

The first TNM classification was introduced in 1968 and following two subsequent revisions the 1987 TNM staging system remained unchanged until recently.

Table A.2 TNM 2002 classification of penile cancer Primary tumor

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

Ta Noninvasive verrucous carcinoma

T1 Tumor invades subepithelial connective tissue

T2 Tumor invades corpus spongiosum or cavernosum

T3 Tumor invades urethra or prostate

T4 Tumor invades other adjacent structures

Regional lymph nodes

NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single superficial inguinal lymph node

N2 Metastasis in multiple or bilateral superficial inguinal lymph nodes

N3 Metastasis in deep inguinal or pelvic lymph node(s), unilateral or bilateral

Distant metastasis (M)

MX: Distant metastasis cannot be assessed

M0: No distant metastasis

M1: Distant metastasis

An additional prognostic grouping has also been developed and recently modified.

Table A.3 Original AJCC/UICC stage groupings Stage 0

More recently this has been modified by the AJCC which has subdivided Stage III into Ilia and

IIIb as shown below Stage IIIa T1-3, N1, M0

The most recent TNM classification was introduced in 2009 which has introduced a subdivision for T1 tumors and redefined the nodal staging.

Table A.4 2009 TNM clinical classification of penile cancer T Primary tumor

TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

Ta Non-invasive verrucous carcinoma, not associated with destructive invasion T1 Tumor invades subepithelial connective tissue

Tumor invades subepithelial connective tissue without lymphovascular invasion and is not poorly differentiated or undifferentiated (T1G1-2)

Tumor invades subepithelial connective tissue without/with lymphovascular invasion or is poorly differentiated or undifferentiated (T1G3-4)

T2 Tumor invades corpus spongiosum or corpus cavernosum

T3 Tumor invades urethra

T4 Tumor invades other adjacent structures

N Regional lymph nodes

NX Regional lymph nodes cannot be assessed

N0 No palpable or visibly enlarged inguinal lymph node

N1 Palpable mobile unilateral inguinal lymph node

N2 Palpable mobile multiple or bilateral inguinal lymph nodes

N3 Fixed inguinal nodal mass or pelvic lymphadenopathy, unilateral or bilateral

M Distant metastases

M0 No distant metastasis

M1 Distant metastasis

2009 TNM pathological classification of penile cancer

The pT categories correspond to the T categories. The pN categories are based upon biopsy, or surgical excision pN Regional lymph nodes:

pNX Regional lymph nodes cannot be assessed pN0 No regional lymph node metastasis pN1 Intranodal metastasis in a single inguinal lymph node pN2 Metastasis in multiple or bilateral inguinal lymph nodes pN3 Metastasis in pelvic lymph node(s), unilateral or bilateral or extranodal extension of regional lymph node metastasis pM Distant metastases pM0 No distant metastasis pM 1 Distant metastasis

(continued)

Table A.4 (continued)

G Histopathological grading

GX Grade of differentiation cannot be assessed

G1 Well differentiated

G2 Moderately differentiated

G3-4 Poorly differentiated/undifferentiated

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

Get My Free Ebook


Post a comment