Pattern and clinical management of penile cancer in Rwanda

Abstract

IntroductionPenile cancer is rare in developed countries but has a high prevalence in some developing countries. Surgery includes inguinal lymphadenectomy, which remains the mainstay treatment of the disease. ObjectiveThis study reports on the epidemiological profile of penile cancer and clinical management options in Rwanda. Patients and methodsFrom January 2015 to June 2016, a multicenter cross-sectional, prospective cohort study was conducted involving all male patients presenting with penile cancer after two national radio campaigns and a Ministry of Health instruction to all district hospitals. All patients with positive biopsy were included. Surgical treatment aligned with published guidelines. Clinical characteristics, surgery, pathology, and early follow-up data were collected. ResultsOver 18 consecutive months, 30 male patients were enrolled. The mean age was 60years [range 33–83]. All patients were uncircumcised before symptom onset; 50% had phimosis and 20% were HIV-positive. The estimated prevalence of penile cancer in Rwanda was 0.37 per 100,000 men. At presentation, 96.7% of patients had a T2-4 disease and 43.3% were with clinically non-palpable inguinal lymph nodes (cNO). After penectomy, bilateral inguinal lymphadenectomy was performed in 10 (33.3%) patients (modified and radical in 16 and 4 limbs, respectively). Complications included surgical site infection (10%), lymphocele (10%), urethral meatus stenosis (6.7%), skin necrosis (3.3%) and two (6.7%) patients with metastatic disease died in hospital. ConclusionPenile cancer is a rare but significant disease in Rwanda. Patients present with advanced disease. After treatment of the primary tumor, modified inguinal lymphadenectomy appears to be a safe method of cure and staging for patients with clinically impalpable inguinal lymph nodes. Our early results provide a compelling insight into this rare but serious disease.