Stage IV penile cancer is defined by the following TNM classifications:

• T4, any N, M0
• Any T, N3, M0
• Any T, any N, M1

No standard treatment exists that is curative for patients with stage IV penile cancer. Therapy is directed at palliation, which may be achieved either with surgery or radiation therapy.

STANDARD TREATMENT OPTIONS:

1. Palliative surgery may be considered for control of the local penile lesion and even for the prevention of the necrosis, infection, and hemorrhage that can result from neglected regional adenopathy.
2. Radiation therapy may be palliative for the primary tumor, regional adenopathy, and bone metastases.

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Clinical trials combining chemotherapy with palliative methods of local control are appropriate for such patients (tested chemotherapeutic drugs with some efficacy include vincristine, cisplatin, methotrexate, and bleomycin). The combination of vincristine, bleomycin, and methotrexate has been effective both as adjuvant and neoadjuvant therapy.[1] Information about ongoing clinical trials is available from the NCI Web site .

References:

1. Pizzocaro G, Piva L: Adjuvant and neoadjuvant vincristine, bleomycin, and methotrexate for inguinal metastases from squamous cell carcinoma of the penis. Acta Oncol 27 (6b): 823-4, 1988.