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Penile Cancer 30 (1)

Total questions: 30

Worksheet time: 15mins

Name
Class
Date
1.

Which of the following is the most common histological type of penile cancer?

a)

Basal cell carcinoma

b)

Adenocarcinoma

c)

Melanoma

d)

Squamous cell carcinoma

e)

Sarcoma

2.

Penile cancer is most strongly associated with:

a)

HPV types 16 and 18

b)

Circumcision at birth

c)

Smoking cessation

d)

Lack of neonatal circumcision

e)

Use of condoms

3.

The precursor lesion most associated with invasive penile squamous cell carcinoma is:

a)

Sebaceous cyst

b)

Angiokeratoma

c)

Erythroplasia of Queyrat

d)

Angiosarcoma

e)

Balanitis xerotica obliterans

4.

Which HPV subtype is most strongly associated with penile carcinoma?

a)

HPV 6

b)

HPV 11

c)

HPV 16

d)

HPV 31

e)

HPV 2

5.

Penile cancer most frequently originates from which part of the penis?

a)

Shaft skin

b)

Glans penis

c)

Urethral meatus

d)

Prepuce

e)

Penile root

6.

The histologic subtype of penile SCC with the best prognosis is:

a)

Basaloid

b)

Verrucous

c)

Sarcomatoid

d)

Warty-basaloid

e)

Mixed

7.

Which of the following is the most important prognostic factor in penile carcinoma?

a)

Patient age

b)

HPV status

c)

Tumor size

d)

Inguinal lymph node involvement

e)

Tumor location

8.

Carcinoma in situ of the glans penis is called:

a)

Bowen disease

b)

Erythroplasia of Queyrat

c)

Zoon balanitis

d)

Condyloma

e)

Kaposi sarcoma

9.

The TNM staging system for penile cancer includes assessment of:

a)

PSA level

b)

Inguinal lymph node status

c)

Gleason score

d)

Epididymal involvement

e)

Penile curvature

10.

What is the standard treatment for CIS of the glans penis?

a)

Total penectomy

b)

Inguinal lymphadenectomy

c)

Topical 5-fluorouracil or imiquimod

d)

Chemoradiation

e)

Partial amputation

11.

A 50-year-old man with T1G2 penile SCC and no palpable nodes. What is the next best step?

a)

Radical penectomy

b)

Dynamic sentinel lymph node biopsy

c)

Inguinal dissection

d)

Chemotherapy

e)

Pelvic lymph node dissection

12.

The risk of inguinal lymph node metastasis is highest in:

a)

Grade 1, T1 tumors

b)

Tis tumors

c)

T2 or higher with grade 2-3

d)

Verrucous carcinoma

e)

HPV-negative lesions

13.

Which of the following is true regarding prophylactic circumcision and penile cancer?

a)

No effect

b)

Protective if done neonatally

c)

Increases risk

d)

Increases HPV transmission

e)

Causes scarring and risk of cancer

14.

The most appropriate treatment for a small (<2 cm), well-differentiated lesion on the glans is:

a)

Total penectomy

b)

Pelvic radiation

c)

Wide local excision or laser therapy

d)

Neoadjuvant chemotherapy

e)

Brachytherapy

15.

The usual presentation of penile cancer includes:

a)

Hematuria

b)

Non-healing ulcer or mass on the glans or foreskin

c)

Testicular swelling

d)

Dysuria

e)

Inguinal abscess

16.

Which histologic feature indicates aggressive penile carcinoma?

a)

Papillomatous pattern

b)

Verrucous variant

c)

Sarcomatoid differentiation

d)

Keratin pearls

e)

Pagetoid spread

17.

The best imaging modality for detecting pelvic lymph node metastasis in penile cancer is:

a)

Chest X-ray

b)

Bone scan

c)

CT scan abdomen and pelvis

d)

KUB

e)

MRI brain

18.

Sentinel lymph node biopsy is best used for:

a)

Tis lesions

b)

Palpable nodes

c)

Clinically node-negative, T1G2 or higher tumors

d)

T3 disease

e)

Post-chemotherapy staging

19.

The most effective systemic therapy for advanced penile SCC is:

a)

Imatinib

b)

Cisplatin-based chemotherapy

c)

Bevacizumab

d)

Pembrolizumab alone

e)

Ketoconazole

20.

Which of the following penile lesions has the lowest risk of malignant transformation?

a)

Lichen sclerosus

b)

Condyloma acuminatum

c)

Erythroplasia of Queyrat

d)

Bowen disease

e)

Balanitis xerotica obliterans

21.

Which of the following is the most appropriate management of palpable, mobile inguinal lymph nodes in a patient with penile SCC?

a)

Observation only

b)

Antibiotics for 4-6 weeks, then reassess

c)

Immediate pelvic lymphadenectomy

d)

Chemotherapy

e)

Radiation therapy

22.

Penile SCC with bilateral fixed inguinal nodes and pelvic lymphadenopathy is best managed with:

a)

Immediate surgery

b)

Radiation therapy only

c)

Neoadjuvant chemotherapy followed by surgery

d)

Topical therapy

e)

Brachytherapy

23.

Which of the following histologic subtypes has the worst prognosis in penile SCC?

a)

Warty

b)

Basaloid

c)

Sarcomatoid

d)

Papillary

e)

Verrucous

24.

Penile preserving surgery is NOT suitable for:

a)

Superficial glans lesions

b)

CIS

c)

Corpus cavernosum invasive T3 tumors

d)

Distal foreskin lesions

e)

Small verrucous carcinoma

25.

What is the typical lymphatic drainage pathway from the penis?

a)

Deep inguinal → pelvic nodes

b)

Superficial → deep inguinal → pelvic nodes

c)

Direct to external iliac nodes

d)

Direct to obturator nodes

e)

Retroperitoneal directly

26.

Which of the following treatments provides the highest local control in T2 penile cancer?

a)

Laser ablation

b)

Mohs surgery

c)

Partial penectomy

d)

Topical 5-FU

e)

Radiation therapy

27.

Which penile cancer stage is defined as invasion into the corpus spongiosum without lymphovascular invasion?

a)

Tis

b)

T1

c)

T2

d)

T3

e)

T4

28.

The risk of nodal metastasis in T1G1 penile cancer is approximately:

a)

<5%

b)

10-15%

c)

30-40%

d)

50%

e)

>75%

29.

Which is the most sensitive modality for detecting pelvic nodal metastasis in penile cancer?

a)

Ultrasound

b)

CT scan

c)

MRI

d)

PET alone

e)

KUB

30.

Indication for pelvic lymphadenectomy in penile SCC includes:

a)

All T1 lesions

b)

Presence of HPV

c)

Confirmed ≥2 positive inguinal lymph nodes

d)

Tumor size >1 cm

e)

Any CIS

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