Diagnosis of Penis Cancer
Penis Cancer Diagnosis: Book Excerpts
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PAIN IN THE PENIS:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is the pain mostly during micturition? If the pain is mostly during micturition, one should consider the possibilities of urethritis, cystitis, bladder calculus, prostatitis, urethral stricture, carcinoma of the bladder, seminal vesiculitis, anal fissure, and hemorrhoids.
- If the pain is during micturition, is it mostly at the end of micturition? If the pain in the penis is at the end of micturition, chronic prostatitis, seminal vesiculitis, anal fissure, hemorrhoids, and bladder calculi should be suspected.
- Is the pain mostly during an erection? If the pain is mostly during an erection, Peyronie's disease should be considered.
- Is the pain unrelated to micturition or erection? If the pain is not related to micturition or erection, renal colic, epithelioma, appendicitis, anxiety, chancroid, and herpes simplex should be considered.
- Is there a discharge? The presence of a urethral discharge should make one think of gonorrhea and nonspecific urethritis.
DIAGNOSTIC WORKUP
The most important diagnostic procedure is a urinalysis, urine culture and sensitivity, and smear and culture of any urethral discharge. It may be necessary to massage the prostate to obtain an adequate specimen! An intravenous pyelogram should be done if obstructive uropathy or bladder or renal calculi are suspected. If the above studies are negative, referral to a urologist should be made. He will probably do cystoscopy and retrograde pyelography as well as other diagnostic tests.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Penile Discharge:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Infection
–Neisseria gonorrhoeae: Profuse, purulent, thick yellow or gray discharge; presents as urethral discharge and dysuria, ±urinary urgency or frequency; untreated primary gonorrhea may progress to disseminated gonococcal infection [clinical triad includes tenosynovitis (asymmetric, involving small joints), dermatitis (erythematous macules that progress to pustules with a hemorrhagic component), and arthritis]
–Chlamydia trachomatis: Most common cause of nongonococcal urethral discharge; thin, scant, and mucoid (watery)
–Trichomonas vaginalis: Usually asymptomatic in men but may present with penile discharge and dysuria; female partner tends to be symptomatic, with pelvic pain, itching, and vaginal discharge
-
Nonspecific urethritis
-
Prostatitis
-
Carcinoma of the urethra
–Presents with bloody penile discharge
-
Foreign body in the urethra
–Presents with pain and bloody discharge
- Reiter's syndrome
–Triad of urethritis, conjunctivitis, and arthritis (“can’t see, can’t pee, can’t climb a tree”) is associated with Chlamydia infection
–Skin lesions involve the palms and soles, begin as vesicles, and become hyperkeratotic
- Lack of circumcision may increase the risk of HIV, gonorrhea, and ulcerative chancres (syphilis)
Workup and Diagnosis
-
History and physical examination, including sexual history and genital exam
–Note onset, duration, and character of discharge (thin versus thick; color; presence of blood or odor) -
Urethral cultures are the gold standard for diagnosis of gonorrhea and Chlamydia
–Obtain cultures by holding the penis up and carefully inserting the tip of the culture swab into the meatus about 1/2 inch; twirl, remove, and place in culture medium
Urinalysis and urine culture
-
Wet mount to evaluate for trichomonads
–To express penile discharge, have the patient “milk” the penis from the base up to the tip
Further STD workup may include HIV, RPR, hepatitis B studies, and hepatitis C antibody
Obtain blood cultures, CBC, and joint fluid aspiration in suspected disseminated gonococcal infection
If foreign body is suspected, obtain plain film X-rays of the penis and pelvis
Urologic consult if diagnosis is unclear or foreign body is identified and needs to be removed
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
PENILE PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Finding any lesion of the penis should prompt a smear and culture of the exudate or scrapings. A dark field examination will often be indicated by the history of sexual contact. Any urethral discharge must also be examined after a Gram stain and cultured for gonococci and Chlamydia. Prostatic massage may be necessary to get adequate urethral material. Next, a urinalysis is done and a fresh drop is examined under high power for motile bacteria signifying cystitis or pyelonephritis. A urine culture and colony count will be wise in any case. If the diagnosis is still obscure, it is wise to consult a urologist before proceeding with an IVP or other expensive tests.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Genital lesions in the male:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Introduction: Malignant Neoplasms:
Diagnostic methods
(Professional Guide to Diseases (Eighth Edition))
A thorough medical history and physical examination should precede sophisticated diagnostic procedures. Useful tests for the early detection and staging of tumors include X-ray, endoscopy, isotope scan, computed tomography scan, and magnetic resonance imaging, but the single most important diagnostic tool is a biopsy for direct histologic study of tumor tissue. Biopsy tissue samples can be taken by curettage, fluid aspiration (pleural effusion), fine-needle aspiration biopsy (breast), dermal punch (skin or mouth), endoscopy (rectal polyps), and surgical excision (visceral tumors and nodes).
An important tumor marker, carcinoembryonic antigen (CEA), although not diagnostic by itself, can signal malignancies of the large bowel, stomach, pancreas, lungs, and breasts. CEA titers range from normal (less than 5 ng) to suspicious (5 to 10 ng) to suspect (over 10 ng). CEA serves many valuable purposes:
❑as a baseline during chemotherapy to evaluate the extent of tumor spread
❑to regulate drug dosage
❑to prognosticate after surgery or radiation
❑to detect tumor recurrence.
Although no more specific than CEA, alpha-fetoprotein — a fetal antigen uncommon in adults — can suggest testicular, ovarian, gastric, and hepatocellular cancers. Beta human chorionic gonadotropin may point to testicular cancer or choriocarcinoma. Other commonly used tumor markers include prostate-specific antigen to detect and monitor prostatic cancer, and CA-125, useful for monitoring ovarian, colorectal, and gastric cancers.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Penile cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis of penile cancer requires a tissue biopsy.
CONFIRMING DIAGNOSIS Preoperative baseline studies include complete blood count, urinalysis, an electrocardiogram, and a chest X-ray. Enlarged inguinal lymph nodes due to infection (caused by primary lesion) make detection of nodal metastasis by preoperative computed tomography scan difficult.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Malignant spinal neoplasms:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
❑Spinal and lumbosacral magnetic resonance imaging confirm spinal tumor.
❑ X-rays show distortions of the intervertebral foramina; changes in the vertebrae or collapsed areas in the vertebral body; and localized enlargement of the spinal canal, indicating an adjacent block.
❑ Myelography identifies the level of the lesion by outlining it if the tumor is causing partial obstruction; it shows anatomic relationship to the cord and the dura. If obstruction is complete, the injected dye can't flow past the tumor. (This study is dangerous if cord compression is nearly complete because withdrawal or escape of cerebrospinal fluid (CSF) will allow the tumor to exert greater pressure against the cord.)
❑ Radioisotope bone scan demonstrates metastatic invasion of the vertebrae by showing a characteristic increase in osteoblastic activity.
❑ Computed tomography scan shows cord compression and tumor location.
❑ Frozen section biopsy at surgery identifies the tissue type.
❑ Lumbar puncture may be normal, abnormal, or nonspecific. It may show clear yellow CSF as a result of increased protein levels if the flow is completely blocked. If the flow is partially blocked, protein levels rise, but the fluid is only slightly yellow in proportion to the CSF protein level. Cytology of the CSF may show malignant cells of metastatic carcinoma.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Genital lesions in the male:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, the number of sexual partners, and the pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient’s vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Genital lesions in the male:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesions. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Genital lesions, male:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by asking the patient when he first noticed the lesion. Did it erupt after he began taking a new drug or after a trip out of the country? Has he had similar lesions before? If so, did he get medical treatment for them? Find out if he has been treating the lesion himself. If so, how? Does the lesion itch? If so, is the itching constant or does it bother him only at night? Note whether the lesion is painful. Ask for a description of any drainage from the lesion. Next, take a complete sexual history, noting the frequency of relations, number of sexual partners, and pattern of condom use.
Before you examine the patient, observe his clothing. Do his pants fit properly? Tight pants or underwear, especially those made of nonabsorbent fabrics, can promote the growth of bacteria and fungi. Examine the entire skin surface, noting the location, size, color, and pattern of the lesions. Do genital lesions resemble lesions on other parts of the body? Palpate for nodules, masses, and tenderness. Also, look for bleeding, edema, or signs of infection, such as purulent drainage or erythema. Finally, take the patient's vital signs.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
PENILE PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Finding any lesion of the penis should prompt a smear and culture of
the exudate or scrapings. A dark field examination will often be indicated
by the history of sexual contact. Any urethral discharge must also be
examined after a Gram stain and cultured for gonococci and Chlamydia. Prostatic
massage may be necessary to get adequate urethral material. Next, a
urinalysis is done and a fresh drop is examined under high power for motile
bacteria signifying cystitis or pyelonephritis. A urine culture and colony
count will be wise in any case. If the diagnosis is still obscure, it is
wise to consult a urologist before proceeding with an intravenous pyelogram
(IVP) or other expensive tests.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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