Penis ve Üretra Kanseri
Özet
Penis ve üretra kanserleri, nadir görülen kanserlerdir. Erken tanı ve uygun tedavi ile bu kanserler başarılı bir şekilde yönetilebilir. Ancak tedavi sonrasında kanserin nüks etme riski göz önünde bulundurularak düzenli takip yapılması büyük önem taşır.
Penis kanserinde organ koruyucu cerrahilerin uygulanmasıyla lokal bölgelerde daha sık nüks görülmüştür, bu durum hasta takibini daha önemli hale gelmektedir. Bölgesel muayeneler ile lokal nüksler fark edilebilir. Lenf nodu metastazı görülmeyen hastalarda ekstra görüntüleme yapmanın faydası tam olarak ispatlanamamıştır. Bu nedenle, hastaların kendi kendilerine penis muayenesi yapabilmeleri, inguinal bölgedeki lenf nodlarını değerlendirebilmeleri ve bölgesel değişiklikleri takip edebilmeleri konusunda eğitim almaları, hasta takibinin bir parçasıdır. Organ koruyucu cerrahi uygulanan hastaların, ilk iki yıl boyunca üç ayda bir, üçüncü ve beşinci yıllar arasında ise altı ayda bir fizik muayene ile değerlendirilmesi tavsiye edilmektedir. Total- parsiyel penektomi geçiren hastaların takibi, ilk iki yıl içinde üç ila altı ay aralıklarla, sonrasında ise yılda bir kez yapılmalıdır. Lenf nodu diseksiyonu yapılmamış veya diseke edilip patoloji sonucu nod negatif çıkan hastalar için fizik muayene, ilk iki yıl boyunca üç ila altı ayda bir, üçüncü ve beşinci yıllar arasında ise yılda bir kez önerilmektedir Lenf nodu diseke edilip nod pozitifliği olan hastalar ise ilk iki yıllık sürede üç ayda bir; iki ile beşinci yıllarda ise altı ayda bir fizik muayene toraks ve abdominal bilgisayarlı tomografi (BT) ya da manyetik rezonans görüntüleme (MRI) ile takip edilmelidir.
Üretra kanseri için genel onkolojik takip prensiplerine göre ilk 2 yıl 3-6 ayda bir, sonraki 5 yıl boyunca 6 ayda bir kontroller yapılması önerilmektedir. 5 yılın ardından yıllık izlem yapılabilir; ancak takip protokolleri her hasta için kişiye özel olarak belirlenmeli, hastanın semptomları ve genel durumu dikkate alınarak bu sıklıklar zaman içinde gözden geçirilmelidir.
Cancers of the penis and urethra are rare cancers. With early diagnosis and appropriate treatment, these cancers can be successfully managed. Surgical intervention, chemotherapy (CT) and radiotherapy (RT) are usually used in combination in the treatment process. However, given the risk of cancer recurrence after treatment, regular follow-up is of great importance.
The rise in organ-sparing therapies for penile cancer has led to an increased incidence of local recurrence, making post-treatment follow-up essential. Local recurrences can often be detected through physical examination of the penis and inguinal region, while the benefit of additional imaging in patients without lymph node involvement remains unproven.
Patient education on self-examination of the penis and inguinal lymph nodes, along with monitoring regional changes, is a key aspect of follow-up. For those undergoing organ-preserving treatment, physical exams are recommended every three months for the first two years and every six months between years three and five. Patients who have had partial or total penectomy should be monitored every three to six months in the first two years and annually thereafter. Similarly, individuals with N0 pathology after inguinal lymph node dissection or those without dissection should have physical exams every three to six months during the first two years and annually from years three to five. In contrast, patients with positive lymph node pathology after dissection should undergo exams every three months for the first two years and every six months between years two and five, with thoracic and abdominal CT or MRI as needed.
For urethral cancer, general oncological guidelines recommend follow-ups every three to six months for the first two years and every six months for the next five years. After five years, annual follow-ups may be conducted, though protocols should be individualized and adjusted based on symptoms and overall health.
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