Visceral and Bone Metastases

Advanced cancers can present with visceral metastases particularly to the lungs and liver. The overall prognosis in these patients is very poor and surgery is limited to palliative relief of urinary symptoms or ureteric obstruction due to extensive pelvic disease.

Proximal extension of penile tumors can involve the inferior pubic rami due to local infiltration. If this is the solitary area of osseous involvement, an inferior pubectomy can be performed at the same time as the radical penectomy. Extensive recurrent disease has been treated in a small series by performing a hemipelvectomy which is only a realistic option for younger patients with unilateral disease.33 In this particular series seven patients underwent a hemipelvectomy of which four died within 12 months.

Symptomatic osseous metastases to long bones can result in pathological fractures and therefore early fixation of these areas is indicated.

Anorectal involvement: Advanced cancers infiltrating into the anorectal areas can result in a series of debilitating symptoms including rectal bleeding, tenes-mus, irretractable pain, and bowel obstruction. Once these symptoms have manifested, the tumor is generally irresectable from the anorectal area and palliative diversion using a colostomy is indicated. A colostomy allows palliative radiotherapy to be given to the anorectal region for pain relief and provide local control.

Where the tumor has infiltrated the prostate or bladder with early local extension into the rectum, a complete pelvic exenteration can be planned in order to remove the entire mass and combine this with a urinary diversion and colostomy.

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