Analysis on cancer incidence and mortality attributed to human papillomavirus infection in China, 2016 / 中华流行病学杂志

Objective: We aim to evaluate the morbidity and mortality of cancer attributable to human papillomavirus (HPV) infection in China in 2016. Methods: Based on the cancer incidence and mortality rates, national population data, and population attributable fraction (PAF) in China, we calculated the number of incidence and death cases attributed to HPV infection in different areas, age groups, and gender in China in 2016. The standardized incidence and mortality rates for cancer attributed to HPV infection were calculated by using Segi's population. Results: In 2016, a total of 124 772 new cancer cases (6.32 per 100 000) were attributed to HPV infection in China, including 117 118 cases in women and 7 654 cases in men. Of these cancers, cervical cancer was the most common one, followed by anal cancer, oropharyngeal cancer, penile cancer, vaginal cancer, laryngeal cancer, oral cancer, and vulvar cancer. A total of 41 282 (2.03 per 100 000) deaths were attributed to HPV infection, of which 37 417 occurred in women and 3 865 in men. Most deaths were caused by cervical cancer, followed by anal cancer, oropharyngeal cancer, penile cancer, laryngeal cancer, vaginal cancer, oral cancer, and vulvar cancer. The incidence and mortality rates of cervical cancer increased rapidly with age, peaked in age group 50-54 years, then decreased obviously. The morbidity and mortality rates of non-cervical cancer increased with age. The cancer case and death numbers in rural areas (57 089 cases and 19 485 deaths) were lower than those in urban areas (67 683 cases and 21 797 deaths). However, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of cervical cancer were higher in rural areas than in urban areas. There were no significant differences in ASIR and ASMR of non-cervical cancers between urban areas and rural areas. Conclusions: The incidence of cancers attributed to HPV infection in China was lower than the global average, but the number of incidences accounted largely, furthermore there is an increasing trend of morbidity and mortality. The preventions and controls of cervical cancer and male anal cancer are essential to contain the increases in cancer cases and deaths attributed to HPV infection.

Caracterización de pacientes tratados por cáncer de pene, con invasión de ganglios locorregionales en el Servicio de Urología del HCIPS de Asunción del Paraguay / Characterization of Patients treated for Penile Cancer with Locoregional Nodes Invasion in HCIPS Urology Unit, Asunción del Paraguay

Introducción: El cáncer de pene tiene una alta incidencia en Latinoamérica, siendo el carcinoma epidermoide el tipo histológico más frecuente. También es sabido que el cáncer de pene suele presentar diseminación a los ganglios linfáticos inguinales, antes de la progresión a la enfermedad metastásica. Objetivo: Caracterizar a los pacientes tratados por cáncer de pene con invasión locorregional en el Servicio de Urología del Hospital Central del Instituto de Previsión Social (HCIPS) de Asunción del Paraguay. Materiales y métodos: Se realizó un estudio retrospectivo, de pacientes tratados con cáncer de pene con invasión locorregional entre los años 2014 y 2017. Se analizaron las siguientes variables: estadificación, tratamientos empleados según la clasificación y complicaciones. Resultados: Los 18 pacientes tratados por cáncer de pene con invasión locorregional fueron adultos mayores, con una edad media de 78,5 años. El tipo de intervención más frecuente fue la linfadenectomía inguinal bilateral (44%). Solo cuatro pacientes fueron sometidos simultáneamente a penectomía y linfadenectomía. Las complicaciones posoperatorias se presentaron en 8 casos (44%), siendo el linfedema la más frecuente. Conclusiones: Los factores pronósticos adversos más importantes son la presencia de adenopatías, el estadío clínico al diagnóstico y el grado de diferenciación celular. El tratamiento más eficaz del cáncer de pene es quirúrgico, reservando la quimioterapia y la radioterapia para adyuvancia o terapia de rescate, siendo las complicaciones más graves, mientras más radical sea la cirugía.(AU)

Introduction: Penile cancer has a high incidence in Latin America, with squamous cell carcinoma being the most frequent histological type. It is also known that penile cancer has a spread to the inguinal lymph nodes, before the progression to metastatic disease. Objective: Characterize the patients treated for penile cancer with locoregional invasion in the Urology Service of the Hospital Central del Instituto de Previsión Social (HCIPS), Asunción of Paraguay. Materials and methods: A retrospective study was conducted of patients treated with penile cancer with locoregional invasion between 2014 and 2017. The following variables were analyzed: staging, treatments used according to the classification and complications. Results: The 18 patients treated for penile cancer with locoregional invasion were older adults, with an average age of 78.5 years. The most frequent type of intervention was the bilateral ilioinguinal (44%). Only four patients were subjected simultaneously to penectomy and lymphadenectomy. Postoperative complications occurred in 8 cases (44%), lymphedema being the most frequent. Conclusions: The most important adverse prognostic factors are the presence of adenopathies, the clinical stage at diagnosis and the degree of cell differentiation. The most effective treatment of penile cancer is surgical, reserving chemotherapy and radiotherapy for adjuvance or rescue therapy, being the complications more serious, the more radical the surgery is.(AU)

Epidemiological study of penile cancer in Pernambuco: experience of two reference centers

Objectives To investigate and analyze the epidemiological profile of penile cancer in the state of Pernambuco and compare this information with other studies related to the issue. Material and Methods We conducted a retrospective, observational and descriptive study of all patients with penile cancer in two reference centers in Pernambuco - Brazil, from 2007 to 2012. The variables studied were: age, region from the state, socio-economic situation, previous postectomy, smoking, time from the beginning of injury to diagnosis, staging of the primary lesion, tumor differentiation, treatment performed and death due to cancer. Results The total number of patients was 88. The highest prevalence was seen in those aged between 66 and 75 years. About the socio-economic situation, 67% worked informally and 64.8% received up to two minimum wages. Of all patients, 57% were married and 50% illiterate. The Metropolitan Region of Recife was the one with the highest number of cases, 41%. Tobacco smoking was reported in 48.9% of cases and prior postectomy in 3.4%. Most often it was observed an average period of six months from the onset of symptoms to diagnosis. And when the lesion was diagnosed, it usually had 2 to 5 cm (64.7%), stage T2 in 50% and well differentiated in 79.6%. Partial penectomy was performed in 76.1% and total in 17%. Death was observed in 27.3%. Conclusion The clinical profile and epidemiological characteristics found in this study are similar to other national and international studies related to the issue, i.e., typical of underdeveloped or developing countries. .

Relación entre los factores clínico patológicos y enfermedad ganglionar inguinal en cáncer de pene / Relation between clinical pathological factors and inguinal node disease in pennies cancer

Determinar la relación entre factores clínicopatológicos y enfermedad ganglionar inguinal en cáncer de pene, en los pacientes del Instituto de Oncología “Dr. Miguel Pérez Carreño”. Estudio retrospectivo, descriptivo, transversal, de 76 pacientes con cáncer de pene1995-2011. Un total de 76 pacientes, 20 (26,31%) entre los 51-60 años, siendo el grupo etario con mayor incidencia; el estadio más frecuentemente el IIIB con 23 casos (30,26%), histología predominante carcinoma epidermoide 62 casos (81,57%); la invasión angiolinfática positiva 37 pacientes y 19 casos (51,35%), presentaron metástasis ganglionar inguinal, y 31 casos (45,58%) sin invasión angiolinfática 0% de metástasis. Grado histológico: Los tumores GI 41 de 76 casos (54%), el 29,2% (12 casos) se presentó con metástasis inguinal, los tumores GII y GIII el 77% (17 casos), y 100% (5 casos) respectivamente; en relación al (T), grado histológico y metástasis inguinales, los T1G1 fueron los más frecuentes, con 22 casos, solo 1 de ellos con metástasis, de los T2, los T2G2 fue el de mayor frecuencia con 8 casos, 6 de ellos, con metástasis ganglionar inguinal, los T3G1, estuvo conformado por 10 pacientes, siendo el de mayor número de pacientes, 5 de ellos presentaron metástasis ganglionar inguinal; el resto de T3 y T4 presentaron MT. El grado histológico asociado a la profundidad de invasión y la invasión linfovascular son factores predictivos importantes de enfermedad ganglionar en cáncer de pene.

To determine the relationship between the clinics pathological factors and the presence of inguinal nodal disease in penile cancer in patients view in the Oncology Institute Dr. Miguel Pérez Carreño. Retrospective, descriptive and transversal investigation, with 76 patients with diagnostic of penile cancer view between the years 1995-2011. A total of 76 patients, 20 (26.31%) between 51-60 years old, and the age group with the highest incidence, stage IIIB more frequently with 23 cases (30.26%), squamous cell carcinoma predominant histology 62 cases (81.57%), positive angio lymphatic invasion in 37 patients and 19 (51.35%) had inguinal lymph node metastases, and 31 cases (45.58%) without groin metastases, as to histological grade, tumors GI 41 of 76 cases (54%), 29.2% (12 cases) presented with inguinal metastases, GII and GIII tumors 77% (17 cases), and 100% (5 cases) respectively, in terms of the (T), histological grade and metastatic inguinal T1G1 were the most frequent, with 22 cases, only 1 patient with metastasis, the T2, the T2G2 had the highest frequency of 8 cases 6 of them, with inguinal lymph node metastasis, the T3G1, consisted of 10 patients, with the largest number of patients, 5 of them presented inguinal lymph node metastasis, the rest of T3 and T4 showed metastases. The histological grade associated with the depth of invasion and lymph vascular invasion are important predictors of nodal disease in penile cancer.

Alteração no número de cópias genômicas e expressão gênica em larga escala em carcinomas de pênis / Copy number alterations and gene expression profiling by large-scale analysis in penile carcinomas

O câncer de pênis (CaPe) é uma neoplasia rara que ocorre em homens preferencialmente a partir da sexta década de vida. Análises utilizando métodos em genética molecular são extremamente limitadas nesses tumores. Esse projeto teve como objetivos identificar alterações no número de cópias genômicas e no padrão de expressão gênica, bem como o perfil integrado dos dados genômicos e transcriptômicos, para determinar biomarcadores relevantes em tumores de pênis. Foram obtidas 48 lesões penianas, sendo 43 carcinomas de células escamosas (CEC) primários, dois carcinomas in situ (CIS), uma hiperplasia (HP), uma metástase e uma recidiva. A genotipagem do HPV foi realizada para 47 amostras utilizando o kit Linear Array HPV Test Genotyping (Roche, CA, USA). A plataforma 4x44K (Agilent Technologies, CA, USA) foi utilizada para análises de alterações no número de cópias genômicas (n=43) e na expressão de transcritos (n=42). A análise dos dados genômicos foi realizada no programa Nexus 6.0 (Biodiscovery, CA, USA) e dos dados de expressão pelo software TMeV 4.5 (http://www.tm4.org). A integração dos dados foi realizada em 37 casos com dados disponíveis para as duas metodologias usando a correlação de Pearson. A análise funcional in silico dos genes alterados foi realizada com o software Ingenuity Pathway Analysis (IPA - Ingenuity® Systems, http://www.ingenuity.com). A confirmação dos dados ocorreu por qPCR e FISH para as alterações genômicas e RT-qPCR para a expressão dos transcritos. A genotipagem para o HPV revelou positividade em 14/42 CaPe avaliados (33,3%), dois CIS, uma HP e uma metástase. As análises de aCGH mostraram um perfil genômico distinto para carcinomas verrucosos em relação aos outros subtipos histológicos de CEC. Entre os tumores, foram encontradas 1.074 alterações no número de cópias (média de 28,3±17,8 CNAs/indivíduo). Os ganhos genômicos mais comuns foram detectados em 3q, 5p, 8q, 9p, 9q, 20p e 21p, enquanto as perdas ocorreram em 3p, 8p, 9p, 21p e Y...

Penile cancer is a rare malignancy that occurs predominantly in men after the sixth decade of life. Molecular genetic data in penile cancer are extremely limited. In this study, it was evaluated copy number alterations and global gene expression by large-scale analysis in penile carcinomas, as well as the integrative profile between genomic and transcriptomic data, in order to uncover the main biomarkers in penile tumors. Forty-eight penile lesions were obtained: 43 squamous cell carcinomas (CEC), two in situ carcinoma (CIS), one hyperplasia (HP), one metastasis and one recurrence. HPV genotyping was performed for 47 samples using Linear Array HPV Test Genotyping kit (Roche, CA, USA). Genomic copy number alterations (n=43) and gene expression analysis (n=42) were assessed by 4x44K platforms (Agilent Technologies, CA, USA). Genomic data were analyzed by Nexus 6.0 (Biodiscovery, CA, USA) and gene expression by using TMeV 4.5 software (http://www.tm4.org). Integrative analysis was carried out for 37 penile tumors with both genomic and transcriptomic available data using Pearson correlation. In silico functional analysis of altered genes was performed by Ingenuity Pathway Analysis software (IPA, Ingenuity® Systems, http://www.ingenuity.com). Data confirmation was performed using qPCR and FISH for copy number alterations, and RT-qPCR for transcript expression results. Fourteen out of 42 penile cancers evaluated (33.3%) were positive for HPV infection, as well as two CIS, one HP and one metastasis. In comparison to other CEC subtypes, aCGH analysis showed differential genomic profile for verrucous carcinomas. Considering tumors, it was found 1.074 copy number alterations (in average, 28.3±17.8 CNA/individual). The most common copy number gains were detected in 3q, 5p, 8q, 9p, 9q, 20p and 21p. Chromosomal losses were found in 3p, 8p, 9p, 21p and Y. Specific alterations on chromosomes 3 and 8 were related to worse outcome and shorter survival. Nineteen differential...

Penile Cancer Disparities in Puerto Rican Men as compared to the United States Population

This study compares incidence and mortality of penile cancer in Puerto Rico (PR) with other racial/ethnic groups in the United States (US) and evaluates the extent in which socioeconomic position index (SEP) or its components influence incidence and mortality in PR.

Age-standardized rates were calculated for incidence and mortality based on data from the PR Cancer Registry and the US National Cancer Institute's Surveillance, Epidemiology and End Results program, using the direct method.

PR men had approximately 3-fold higher incidence of penile cancer as compared to non-Hispanic white (Standardized rate ratio [SRR]: 3.33; 95%CI=2.80-3.95). A higher incidence of penile cancer was also reported in PR men as compared to non-Hispanic blacks and Hispanics men. Mortality from penile cancer was also higher for PR men as compared to all other ethnic/racial groups. PR men in the lowest SEP index had 70% higher incidence of penile cancer as compared with those PR men in the highest SEP index. However, the association was marginally significant (SRR: 1.70; 95%CI=0.97, 2.87). Only low educational attainment was statistically associated with higher penile cancer incidence (SRR: 2.18; 95%CI=1.42-3.29).

Although penile cancer is relatively uncommon, our results support significant disparities in the incidence and mortality rates among men in PR. Low educational attainment might influence the high incidence of penile cancer among PR men. Further studies are strongly recommended to explore these disparities. .

Prevalence of human papillomavirus and Epstein-Barr virus DNA in penile cancer cases from Brazil

Penile cancer is a potentially mutilating disease. Although its occurrence is relatively rare worldwide, penile cancer rates can be high in developing countries. A few studies have been conducted on the involvement of human papillomavirus (HPV) in penile carcinoma, which have found HPV present in 30-70 percent of penile malignant lesions, with a higher prevalence of HPV 16 and 18. It has been assumed that cofactors, such as Epstein-Barr virus (EBV) infections, may play a role in the progression of penile neoplasia. The aim of this study was to determine HPV and EBV prevalence in 135 penile malignant lesions from Brazilian men through the use of MY09/11 polymerase chain reaction (PCR), type-specific PCR and restriction fragment length polymorphism analysis. HPV prevalence among the men tested was 60.7 percent. Of the men who tested positive, 27 presented with HPV 16 (29.7 percent), five with HPV 18 (5.5 percent), 21 with HPV 45 (23.1 percent) and nine with HPV 6 (9.9 percent). Seven mixed infections were detected (9.2 percent), while 11 cases remained untyped (13.4 percent). Regarding EBV positivity, 46.7 percent of the samples contained EBV DNA with EBV-1 as the most prevalent type (74.6 percent). More than 23 percent of the men were co-infected with both HPV and EBV, while 35 percent presented exclusively with HPV DNA and 20 percent presented only with EBV DNA. Penile carcinoma aetiology has not been fully elucidated and the role of HPV and EBV infections individually or synergistically is still controversial. Hence, more studies are needed to determine their possible role in carcinogenesis.

Carcinoma de ano, pene, vulva y vagina: ¿son enfermedades de transmisión sexual? / Anogenital neoplasms: are sexually transmitted diseases?

Introducción: La infección por virus papiloma humano (VPH) sería factor causal de cánceres de ano, pene, vulva y vagina. Objetivo: Analizar la evidencia actual en cuanto a infección por VPH y su rol carcinogénico en estas neoplasias. Metodología: Búsqueda de la literatura para identificar artículos sobre la transmisión sexual como factor de riesgo en cánceres anogenitales. Resultados: En lesiones premalignas y malignas anogenitales se encuentra en gran frecuencia el DNA de VPH, especialmente tipo 16. Se ha demostrado que la vacunación contra VPH previene el desarrollo de lesiones preinvasoras anales; en cambio, ni la vacuna ni la circuncisión parecen ser factores protectores contra cáncer de pene. Discusión: No hay estudios prospectivos que permitan establecer una relación causal entre VPH y cánceres anogenitales, lo que impide la elaboración de estrategias de prevención. El manejo de ciertos factores de riesgo sugeridos previamente en la literatura no reduce el riesgo de cáncer anogenital.

Introduction: Human papillomavirus (HPV) infection has been suggested as a causal factor of anal, penile, vulvar and vaginal cancers. Objective: To analyze current evidence about HPV infection and its carcinogenic role in these neoplasms. Methodology: Literature search to identify articles about sexual transmission as a risk factor in anogenital cancers. Results: In premalignant and malignant anogenital lesions, an important presence of HPV DNA is often found, specially type16. It has been demonstrated that HPV vaccine prevents premalignant anal lesions; however, this vaccine and circumcision do not seem to be protective against penile cancer. Discussion: There are no prospective studies that had established a causal relationship between HPV and anogenital cancers. This keeps off the development of adequate prevention strategies. Management of certain previously suggested risk factors do not reduce the risk of anogenital cancer.

Penile cancer in jamaicans managed at the university hospital of the West Indies / El cáncer de pene en jamaicanos tratados en el hospital universitario de West Indies

OBJECTIVES: The aim of this study is to determine the prevalence and clinicopathological correlates of penile cancer as well as the clinical outcomes in a sample of Jamaicans managed at the University Hospital of the West Indies (UHWI). METHODS: All available records of patients diagnosed with penile cancer from 1998-2008 at the UHWI were obtained. Patient demographics, circumcision status, sexually transmitted infection status, lesion duration, location and size, and lymph node status were obtained. Histology, differentiation and stage were recorded. Information was obtained regarding treatment and outcome. The current data were compared with a previous report from UHWI in 1959. RESULTS: The records of 22 of 26 patients with penile cancer were available for review. Mean (SD) age of patients was 68 (13) years. Eighteen (86%) patients were uncircumcised. Mean tumour size was 5.7 (2.6) cm; 8 (36%) lesions involved the entire penis. Sixteen (73%) lesions had clinically regional disease and 11 (52%) patients had advanced pathological stage. Surgical treatment was performed in 15 (68%) patients. Case fatality was 38%, with median survival following surgical intervention of 38 person-months. The major predictor of death in this series was increasing age (HR = 1.06, 95% CI 0.99, 1.1, p = 0.079). There was an increase in age and clinical stage of the cancer at presentation in the current series; however, there was no difference in survival. CONCLUSION: Penile cancer is an uncommon cancer, seen at an advanced stage in Jamaicans. Overall survival is poor and advanced age is a major predictor of death.

OBJETIVOS: El objetivo de este estudio es determinar la prevalencia y los correlatos clínico-patológicos del cáncer de pene así como los resultados clínicos en una muestra de jamaicanos tratados en el Hospital Universitario de West Indies (HUWI). MÉTODOS: Se obtuvieron todas las historias clínicas disponibles de los pacientes diagnosticados con cáncer de pene en el Hospital Universitario de West Indies en el período de 1998-2008. Se obtuvieron datos de los pacientes en relación con la demografía, estado de circuncisión, estado de infecciones de transmisión sexual, duración de la lesión, localización y tamaño, y condición de los nódulos linfáticos. Se registraron datos sobre la histología, la diferenciación y las etapas. Se obtuvo la información con respecto al tratamiento y la evolución clínica. Los datos corrientes se compararon con un informe anterior de UHWI en 1959. RESULTADOS: Las historias clínicas de 22 de 26 pacientes con cáncer de pene, estuvieron disponibles para su revisión. La edad promedio (SD) de los pacientes fue 68 (13) años. Dieciocho (86%) pacientes eran incircuncisos. El tamaño promedio del tumor fue 5.7 (2.6) cm; 8 (36%) lesiones involucraron el pene entero. Dieciséis (73%) lesiones tenían enfermedad regional clínicamente, y 11 (52%) pacientes estaban en la fase patológica avanzada. El tratamiento quirúrgico se realizó en 15 (68%) pacientes. La fatalidad de los casos fue de 38%, con una supervivencia promedio tras intervención quirúrgica de 38 persona-meses. El predictor mayor de muerte en esta serie fue la edad creciente (HR = 1.06, 95% CI 0.99, 1.1, p = 0.079). Se produjo un aumento en la edad y la fase clínica del cáncer con la presentación de la serie corriente. Sin embargo, no hubo ninguna diferencia en relación con la supervivencia. CONCLUSIÓN: El cáncer de pene es un cáncer raro, visto en una fase avanzada en jamaicanos. La supervivencia global es pobre y la edad avanzada es un predictor mayor de muerte.

Epidemiological aspects of penile cancer in Rio de Janeiro: evaluation of 230 cases

PURPOSE: To determine epidemiological characteristics of penile cancer in Rio de Janeiro, its associated risk factors and clinical manifestations. PATIENTS AND METHODS: Between 2002 and 2008 we evaluated 230 patients at three public institutions, considering age, ethnicity, birthplace, marital status, educational level, religion, tobacco smoking, presence of phimosis and practice of circumcision. RESULTS: The ages ranged from 25 to 98 years, with an average of 58.35 years. Of the 230 patients, 167 (72.7 percent) were from the southeast region of Brazil (which includes Rio de Janeiro) and 45 (19.5 percent) were from the northeast of the country. Most patients were white (67.3 percent), married (58.6 percent), smokers (56.5 percent) and had not completed primary school (71.3 percent). The predominant religion was Catholic (74.8 percent). Of the 46 (20 percent) circumcised patients, only 1 (2.2 percent) had undergone neonatal circumcision. Grade I tumors were present in 87 (37.8 percent) of the patients, grade II in 131 (56.9 percent) and grade III in 12 (5.3 percent). Lymphovascular embolization was observed in 63 (27.3 percent) and koilocytosis in 124 (53.9 percent) patients. Of the total, 41.3 percent had corpora cavernosa or corpus spongiosum infiltration, and 40 (17.4 percent) had urethral invasion. Prophylactic lymphadenectomy was performed on 56 (36.1 percent), therapeutic lymphadenectomy on 84 (54.2 percent) and hygienic lymphadenectomy for advanced disease on 15 (9.7 percent) patients. The median time between the lesion onset and clinical diagnosis was 13.2 months. The mean follow up was 28.8 months. CONCLUSION: Most of our patients were born in this state and had low socioeconomic status. Most of them were white men, married, smokers, uncircumcised, of the Catholic faith and in their sixties or older. Their disease was in most cases diagnosed only in the advanced stages.

Aspectos clínico-epidemiológicos associados ao câncer de pênis / Clinico-epidemiological aspects associated with penile cancer

O objetivo desta revisão bibliográfica foi descrever a epidemiologia, o comportamento biológico dos tumores e os fatores de risco para o câncer de pênis, como a infecção pelo HPV. A fimose e os processos de irritação crônica relacionados à má higiene estão comumente associados com esse tumor, enquanto a circuncisão neonatal protege contra a aparição da doença. Existe forte evidência da associação dos HPV 16 e 18 com o carcinoma peniano em mais de 50 por cento dos casos. Pacientes com lesões penianas suspeitas devem se submeter ao exame físico, geralmente sendo este suficiente para determinar o diagnóstico e o estadiamento, assim como auxiliar na escolha terapêutica.

The general objective of this article is to review the current literature regarding the epidemiology, biological behavior and risk factors for penile cancer development, such as HPV infection. Phimosis and chronic irritation related to poor hygiene are commonly associated with penile cancer, whereas neonatal circumcision reduces the relative risk for the disease. There is strong evidence that HPV types 16 and 18 are associated with penile carcinoma in as many as 50 percent of cases. Patients with penile lesions should undergo physical examination, which is often sufficient to diagnose and to define tumor stagging, as well as contributes to decision-making regarding therapeutical approaches and case management.

Estudo epidemiológico do câncer de pênis no Estado do Pará, Brasil / Epidemiological study of penile cancer in Pará State, Brazil

OBJETIVOS: Analisar a epidemiologia do câncer de pênis no Estado do Pará e contribuir com o estudo nacional da Sociedade Brasileira de Urologia, visando a instituição de medidas de prevenção, diagnóstico e tratamento. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, 208 pacientes portadores de carcinoma epidermoide do pênis, no período entre junho de 1996 e junho de 2006, segundo a idade, origem, classe social, tempo entre o aparecimento da lesão primária e a procura de atendimento, localização, estadiamento e grau patológico da lesão. Procurou-se também determinar sua incidência total, prevalência nas diversas mesorregiões do Estado, assim como o coeficiente de prevalência da doença, na instituição onde o estudo foi realizado. RESULTADOS: A maior prevalência foi encontrada na faixa etária entre 41 e 70 anos de idade. As mesorregiões Metropolitana e Nordeste do Pará foram a origem da maioria dos pacientes. Quase todos provinham de classes socioeconômicas baixas, e eram, principalmente, agricultores. O intervalo médio entre o aparecimento da lesão e a procura de atendimento médico foi de 11 meses. A grande maioria das lesões estava localizadas na cavidade prepucial e eram invasivas. A incidência bruta da doença no Estado é de 5,7/100.000 habitantes/ano. Esses tumores representam 15,7 por cento dos tumores urogenitais no sexo masculino e são o segundo mais frequente no Departamento de Urologia. Não se observou nenhum caso da doença na população indígena do Estado. CONCLUSÃO: O câncer de pênis apresenta incidência e prevalência alarmantes no Estado do Pará. Medidas preventivas devem ser implementadas para reduzir a ocorrência da doença nos próximos anos...

OBJECTIVES: To analyze the epidemiology of cancer of the penis in Pará and to contribute to the Sociedade Brasileira de Urologia's national study while also seeking to implement measures of prevention, diagnosis and treatment. METHODS: We retrospectively evaluated 208 patients with epidermoid carcinoma of the penis in the period between June 1996 and June 2006 according to age, origin, social class and time between the onset of the primary lesion and seeking treatment as well as the localization, stage and pathological grade of the lesion. We also sought to determine the overall incidence and prevalence of this cancer in various mesoregions of the State and its prevalence in the institution where the study was conducted. RESULTS: The highest prevalence was found in the age group between 41 and 70 years of age. The Metropolitan and Northeastern Pará mesoregions were the source of most patients. Almost all patients were from low socioeconomic classes and were mainly farmers. The average interval between the appearance of the lesion and seeking medical care was 11 months. The vast majority of the lesions were invasive and located in the preputial cavity. The crude incidence of the disease in the state is 5.7/100,000 inhabitants/year. These tumors account for 15.7 per cent of the male urogenital tumors and are the second most frequently seen in the Department of Urology. No cases of the disease were observed among the indigenous population of the state. CONCLUSION: The prevalence and incidence of penis cancer in the State of Pará is alarming. Preventive measures must be implemented to reduce the occurrence of the disease in coming years...

Carcinoma epidermoide de pene / Penis epidermoidal carcinoma

Se trata de un adulto, blanco, masculino, de 58 años, con antecedentes de hipertensión arterial, y lesiones en el pene desde hace aproximadamente más de veinte años, las cuales fueron aumentando en tamaño, variando su localización. Hace dos años se valoró como un condiloma acuminado, pero no llevó tratamiento. Se valora en nuestro hospital porque veinte días atrás las lesiones tomaron aspecto tumoral, comenzaron a abscedarse, ulcerarse. Se valoró el caso en conjunto con Dermatología, Urología. Después de varios tratamientos antibióticos se logró biopsiar la lesión. El caso es interesante por lo infrecuente de la localización de las lesiones en nuestro paciente y el grado de avance de la enfermedad.

It deals with a 58-years-old male, white man, with antecedents of blood hypertension, and increasing lesions in the penis since around 20 years ago, with changing locations. Two years ago it was diagnosed as acuminated condylomas, but it was not treated. The patient attended our hospital because twenty days ago the lesions adopted a tumor like aspect, and began to get abscessed, to ulcerate. The case was evaluated together with Dermatology and Urology. After some antibiotic treatments, it was obtained a biopsy of the lesion. The case is interesting because of the uncommon localization of the lesions in our patient and the increased level of the disease.

Infection of human papillomaviruses in cancers of different human organ sites.

Clinico-epidemiological and molecular studies have established the casual link between Human Papillomavirus (HPV) infection and cervical cancer as also association of HPV infection with several other cancers. In India, cervical cancer is a leading cancer among women and almost all cases of cervical cancer show prevalence of High Risk (HR)-HPV infection. HPV has been also detected in a significant proportion of oral, esophageal, anal, vaginal, vulvar, and penile cancer and in a small percentage of lung, laryngeal, and stomach cancer in India. Due to lack of organized HPV screening program, insufficient infrastructure and trained manpower and inadequacy in cancer registries, there are not much data available on the countrywide HPV prevalence and its type distribution in different cancers in India. Forthcoming introduction of recently developed HPV vaccines in India given a new urgency to know the prevalence and distribution of various HPV types in different organ sites for the management and monitoring of vaccination program and its impact on prevalence of other cancers. This review, summarizes studies on the prevalence of HPV infection in cancers of different organ sites in India.

Epidemiologic study on penile cancer in Brazil

OBJECTIVES: To assess epidemiologic characteristics of penile cancer in Brazil. MATERIALS AND METHODS: From May 2006 to June 2007, a questionnaire was distributed to all Brazilian urologists. Their patients' clinical and epidemiological data was analyzed (age, race, place of residence, history of sexually transmitted diseases, tobacco smoking, performance of circumcision, type of hospital service), as well as the time between the appearance of the symptoms and the diagnosis, the pathological characteristics of the tumor (histological type, degree, localization and size of lesion, stage of disease), the type of treatment performed and the present state of the patient. RESULTS: 283 new cases of penile cancer in Brazil were recorded. The majority of these cases occurred in the north and northeast (53.02 percent) and southeast (45.54 percent) regions. The majority of patients (224, or 78.96 percent) were more than 46 years of age while only 21 patients (7.41 percent) were less than 35 years of age. Of the 283 patients presenting penile cancer, 171 (60.42 percent) had phimosis with the consequent impossibility to expose the glans. A prior medical history positive for HPV infection was reported in 18 of the 283 cases (6.36 percent). In 101 patients (35.68 percent) tobacco smoking was reported. The vast majority of the cases (n = 207; 73.14 percent) presented with tumors localized in the glans and prepuce. In 48 cases (16.96 percent) the tumor affected the glans, the prepuce and the corpus penis; in 28 cases (9.89 percent) the tumor affected the entire penis. The majority of the patients (n = 123; 75.26 percent) presented with T1 or T2; only 9 patients (3.18 percent) presented with T4 disease. CONCLUSION: Penile cancer is a very frequent pathology in Brazil, predominantly affecting low income, white, uncircumcised patients, living in the north and northeast regions of the country.

De una fimosis a la amputación total del pene / From phymosis to total amputation of the penis

El caso que presentamos es el de un paciente de 53 años que, al no tratarse adecuadamente una fimosis, presentó un carcinoma epidermoide de pene y fue necesario realizar una amputación total de este órgano. Es sabido que en la actualidad ese tipo de enfermedad es prevenible y que su aparición se debe a una higiene genital inadecuada relacionada con la presencia de fimosis o prepucio redundante(AU)

The case of a 53 years-old patient, who did not look for adequate treatment for phymosis and developed epidermoid carcinoma of the penis leading to the total amputation of this organ, was presented in this paper. It is known that this type of disease is preventable at present and that it occurs due to phymosis or redundant foreskin-related poor genital hygiene(AU)

Epidemiología de los cánceres urológicos en la Tercera Región de Atacama / Epidemiology of urological cancers in the Tercera Región de Atacama

Si se consideran todos los cánceres, el cáncer de próstata es el tumor maligno más frecuentemente diagnosticado en E.E.U.U., ocupando el segundo lugar entre las causas de muerte por cánceres en hombres, y el sexto lugar en la incidencia general de cánceres. En relación a las otras neoplasias génitourinarias, los registros internacionales de incidencia y mortalidad para cáncer de vejiga, renal, testicular y peneano son significativamente menores. En nuestro país no se conocen cifras de incidencia real de estas patologías, existiendo registros publicados sólo para algunas regiones y provincias de Chile. El propósito de esta investigación es determinar la magnitud de las tasas de incidencia anuales de estas neoplasias en la III Región de Atacama durante el período anual de septiembre de 2002 a agosto de 2003. Se observaron tasas de incidencia sorprendentemente altas para cáncer de próstata en comparación con otras regiones de Chile (58 x 100.000 hombres y un índice Swarop de 317,4 x 100.000 hombres mayores de 50 años). Para cáncer vesical, la tasa de incidencia fue de 9,40 x 100.000 habs. y 16,93 x 100.000 si consideramos sólo población masculina. La tasa de incidencia real para cáncer renal fue de 6,95 x 100.000 habs. con un índice Swarop de 35,25 x 100.000 habs. mayores de 50 años. En relación al cáncer testicular y de pene se obtuvieron tasas de incidencia de 7,25 x 100.000 hombres y 2,41 x 100.000 hombres, respectivamente. Además, se describen otros atributos y variables epidemiológicas como edad promedio, rangos de edad, tasas ajustadas por grupo etáreo y se esbozan ciertas apreciaciones en relación a eventuales factores de riesgo.