Treatment of Penile Squamous Cell Carcinoma with Palpable Mobile Inguinal Lymph Node Metastases (cN1/cN2)
This protocol addresses the management of penile squamous cell carcinoma in patients who present with palpable, mobile inguinal lymph node involvement — classified as cN1 (unilateral) or cN2 (multiple or bilateral). Inguinal lymphadenopathy at this stage requires a structured surgical and adjuvant approach.
Clinical Scenario
Patients present with palpable mobile inguinal lymph nodes — either a single unilateral node (cN1) or multiple or bilateral nodes (cN2) — representing regional metastases from penile squamous cell carcinoma. Radical inguinal lymph node dissection remains the standard of care at this nodal stage.
Treatment Approach (Partial Overview)
Depending on the extent of pathological nodal involvement, the approach may include pelvic lymphadenectomy and adjuvant locoregional radiotherapy — with the specific sequence, technique, and additional modalities determined by the full protocol.
References
- cN1 Palpable mobile unilateral inguinal lymph node
- cN2 Palpable mobile multiple or bilateral inguinal lymph nodes
- Radical ILND remains the standard of care for patients with cN1–2.
- Offer open or minimally-invasive prophylactic ipsilateral pelvic lymphadenectomy to patients if: three or more inguinal nodes are involved on one side on pathological examination; extranodal extension is reported on pathological examination.
- Offer adjuvant radiotherapy (with or without chemosensitisation) to patients with pN2/N3 disease, including those who received prior neoadjuvant chemotherapy.
- Increased DSS and RFS in penile cancer requires 54Gy for ENE and 57–60Gy for positive margins.
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