Penile Cancer

In Western countries, carcinoma of the penis is a rare neoplasm accounting for less than 1 % of all cancers in males. More than 50 % of patients with squamous cell carcinoma of the penis have lymph node involvement or distant metastasis at initial presentation. Hypercalce-mia is the most common life-threatening metabolic disorder associated with malignancies; it has been rarely been reported in association with primary squamous cell carcinoma of the penis. Ideally, treatment of the primary cancer leads to resolution of this paraneoplastic disorder. However, elevated calcium serum levels often require urgent, nonspecific measures including hyperhydration therapy, diuretics, and biphosphanates (Ma-lakoff and Schmidt 1975; Videtic et al. 1997; Wolchok et al. 1998; Dorfinger et al. 1999; Akashi et al. 2002). A chemotherapy regimen of intravenous cisplatin andfluoro-uracil caused regression of the primary tumor and normalization of the serum calcium. A cohort of 14 men with inoperable or metastatic squamous cell carcinoma of the penis was treated with methotrexate, bleomycin, and cisplatin. In 12 patients the penis was the primary site. Two patients had tumor-related hypercalcemia. Significant responses occurred in ten patients, including both patients with hypercalcemia with correction of the hypercalcemia (Dexeus et al. 1991). Close attention should be given to hypercalcemia in patients with carcinoma of the penis, as it is a life-threatening condition, and monitoring serum calcium levels may serve as tumor marker for therapeutic effects.

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