Penile cancer is a rare type of cancer that occurs on the surface of the penis or within the penis.  Penile cancer not only affects a man physically but can have a negative impact on their mental health. Support throughout their cancer journey is vitally important. Approximately 60 men are diagnosed and treated with penile cancer in Ireland every year. This number is increasing every year. Due to this increase in demand in the service, the National Cancer Control Programme  designated Beaumont Hospital  as the National Referral Centre in Ireland for penile cancer.

Mr. Ivor Cullen, Consultant Urologist, is the clinical lead in Ireland for penile cancer. My name is Alison Doran. I commenced the new role of Clinical Nurse Specialist (CNS) in Penile and Bladder Cancer in May 2023.

Penile cancer most commonly affects men over the age of 50 but can affect younger men also. Risk factors include age, smoking, phimosis, Human Papilloma Virus (HPV) and previous radiation exposure.

The most common symptoms of penile cancer include:
• A growth or sore that doesn’t heal within 4 weeks – it can look like a wart or blister
• Bleeding from your penis or from under the foreskin
• A foul-smelling discharge under the foreskin (not ejaculation)
• Swelling that makes it difficult to draw back the foreskin (phimosis)
• A change in the colour of the skin or foreskin to a blueish / brown colour
• A rash or small crusty bumps on the penis
• Lumps under the skin in the groin area

Investigations may include blood tests, biopsy, CT scan, MRI scan, ultrasound and PET scan.

Treatment options vary depending on the stage, size and position of the cancer. For early staged penile cancer, treatment options can include topical treatments such as chemotherapy or immunotherapy creams. For cancers affecting a wider area, surgery can be the most effective treatment. Some surgery will involve removing small pieces of tissue, while others may involve more extensive procedures which can involve removing the full penis (Total penectomy). Surgery can be given as a sole component or it may be combined with other treatments such as chemotherapy or radiotherapy.
Early detection and self-awareness is vital for patient survival and positive patient outcomes. Self-surveillance is highly advocated for any man with a suspicion or confirmed penile cancer. Recognising changes to the penis should be reported to a healthcare professional.
My aim as CNS is to deliver a high quality service for patients with penile cancer by acting as a specialist resource and working in conjunction with the Multidisciplinary Team. I am the point of contact for these patients and their families through their cancer journey from time of referral through to survivorship. I provide physical, social support and education, through evidence based practice. I advise and educate nursing staff and medical staff on the specific care these patients require both pre and post-operatively.

I am also focused on muscle invasive bladder cancer patients requiring cystectomy. I act as the link between the patient, urology consultant and stoma care specialist nurses. I am the point of contact for these patients and their families both pre and post operatively. For patients requiring robotic assisted cystectomy, I have helped set up and coordinate the Enhanced Recovery after Surgery Programme (ERAS) on St. Damien’s Ward which thus far has proven to be a successful programme. It is comprised of a regime to promote early mobilisation, early oral intake and nutritional optimization. It has many potential benefits including reduced length of stay in hospital, improved wound healing and decreased risk of blood loss.

I can be contacted by phone on 01 797 7491 or email urologyoncology@beaumont.ie.
Penile Cancer referrals can be sent to PCC@BEAUMONT.IE

Visible blood in urine can be due to many reasons, such as infection or trauma, but it may also be a symptom of Urological cancer and it is important it is investigated thoroughly.

In 2019, the Royal College of Surgeons in Ireland in partnership with the National Clinical Programme in Radiology and the National Clinical Programme in Urology Surgery agreed to collaborate in a key quality improvement initiative to develop Rapid Access Haematuria Pathways. In Beaumont Hospital, a visible haematuria pathway was established in 2019 to ensure timely access to for patients with haematuria to be assessed and have diagnostic tests performed. Since then referrals to the service have risen annually from 161 to 483 new patients in 2023 being seen by the service.

How does the pathway work?

1. Initial Assessment: This involves a taking a detailed medical history inquiring about symptoms like pain, frequency, or urgency of urination, and any risk factors for urological problems. Risk factors for urological problems (smoking history, occupational exposures, previous cancer treatments radiation to pelvis, certain chemotherapies, family history, chromic bladder irritation etc.)
2. Urinalysis and Urine Culture: A urinalysis is a test that checks the physical, chemical, and microscopic properties of urine. It can help identify the presence of blood cells, infection, or other abnormalities.  A urine culture is a test to identify any bacteria or other organisms present in the urine, which can cause infections.
3. Blood tests: Blood tests don’t directly diagnose the cause of visible haematuria.  They are used along with other investigations to build a more complete picture and guide further management. Blood tests can include kidney function tests, complete blood count (CBC), clotting tests, prostate-specific antigen (PSA) tests.
4. Imaging Tests: Depending on the patient’s age, risk factors, and initial findings, imaging tests like kidney ultrasound, CT urogram (intravenous pyelogram), or cystoscopy might are recommended.

1. • Kidney ultrasound: This painless procedure uses sound waves to create images of the kidneys, ureters, and bladder. It can help identify any abnormalities in these organs, such as kidney stones or tumors. Click here for more information.
   • CT Urogram: This is an X-ray imaging test that involves injecting a contrast dye into a vein. The dye helps to highlight the urinary system, allowing for a more detailed examination of the kidneys, ureters, and bladder. Click here for more information.

5. Cystoscopy: This is a minimally invasive procedure that uses a thin, flexible tube with a light and camera on the end to examine the inside of the urethra and bladder. It can help to identify any abnormalities in these structures, such as bladder stones or tumours and is the gold standard investigation for bladder cancer
6. Diagnosis and Treatment: Based on the results of the investigations, a diagnosis will be established.  The treatment plan will depend on the underlying cause of the visible haematuria.  In some cases, no treatment may be necessary.  For others, treatment might involve antibiotics (for urinary tract infections), medications to manage kidney stones, or surgery (to remove tumours).

Following this pathway ensures a standardised approach to diagnosing visible haematuria, potentially leading to earlier detection and treatment of urological malignancies. This can significantly improve patient outcomes by:

• Increasing the likelihood of early-stage cancer detection: Early detection of urological malignancies allows for more effective treatment options and a better chance of cure.
• Reducing treatment morbidity: Cancers detected at earlier stages often require less invasive treatments, which can lead to fewer side effects and a quicker recovery time for patients.
• Improving patient survival rates: Early diagnosis and treatment are crucial for improving the overall survival rates of patients with urological malignancies.

Having a visible haematuria pathway ensures that patients with blood in their urine receive a prompt and thorough evaluation, ultimately leading to better patient outcomes.

Urology Nursing Team: Angela Niland ANP Urology/Tx Retrieval
Karen Kelly ANP Urology/Tx Retrieval
Liana Keegan ANP Urology/Tx Retrieval
Clodagh Sharpe ANP Haematuria
Alison Doran CNS Penile, Bladder & Renal
Yemema Kurian CNS Urology

The ‘‘gold standard’’ treatment for surgical management of small kidney cancers has shifted from radical nephrectomy (i.e. total nephrectomy) to robotic partial nephrectomy (RPN). RPN is designed to provide minimally invasive nephron sparing surgery and is technically feasible with the Da Vinci robotic platform. Wristed instrumentation and three-dimensional vision facilitate excellent ergonomics for resection and renorrhaphy; decreased warm ischemia time while preserving oncologic outcomes.

Robotic kidney surgery was introduced to Beaumont in 2020 and approximately 125 robotic kidney cases have been performed to date. Most of these cases are robotic partial nephrectomy for kidney cancer. Given its comparable oncologic outcomes to open surgery and improved patient safety; robotic assisted partial nephrectomy is an exciting innovation that will benefit kidney cancer patients attending Beaumont Hospital for the foreseeable future.

With the spotlight on Upper Gastro Intestinal (UGI) cancers this month we focus on some of the key roles in our expert service at Beaumont RCSI Cancer Centre. Our patients  have access to experts in advanced endoscopic techniques, minimally invasive surgery and structured enhanced recovery programmes and our team of experts continues to grow.

My name is Wendy Hickey. I have recently started working in the role of Registered Advanced Nurse Practitioner (RANP) within the Upper Gastrointestinal (GI) Surgical service here in Beaumont Hospital after completing my MSc in Advanced Nursing Practice in UCD. My role focuses on surveillance and survivorship of for upper GI cancer patients who have completed the active phase of their cancer treatments. I bring my experience of working in Medical Oncology, in St Anne’s ENT/Head and Neck oncology and as an Upper GI CNS for over 12 years to the service. Optimising these patients quality of life and encouraging them to live well beyond their cancer diagnosis is the essence of my new role! I look forward to bringing my experience and knowledge into this new role having worked as the Upper GI CNS for over 12 years within the surgical service.

We are the two Upper GI Cancer Clinical Nurse Specialists (CNS) in Beaumont Hospital, Claire Coleman and Julie Anne Pereras. Within our role we act as the patient’s core link and aim to provide a seamless service for patients diagnosed with Upper GI Cancers. We co-ordinate appointments for all relevant out-patient clinics. We also provide support, guidance and advice to patients and their families both in person and via the phone. We encourage patients and their families to contact us directly in the event of any problems or concerns which we can address directly with the team as necessary. We strive to provide an efficient, effective high quality service whilst representing the needs of the patient. Over recent years we and our ANP Wendy have been involved in many improvements to the service. A significant advancement was the implementation of the Enhanced Recovery After Surgery (ERAS) Pathway for Oesophagectomy and Gastrectomy patients. ERAS is an evidence based multidisciplinary approach designed to decrease the time it takes to recover after surgery, reducing complications along with improving the surgical experience.

The dietetic team specialising in Upper GI Cancer in Beaumont Hospital is growing.  2023 saw our new Senior Dietitian Lynn Fagan join the team, working alongside Linda Moore, Senior Dietitian and Cathy White Clinical Specialist Dietitian.  The newly expanded dietetic service to patients with oesophageal or gastric cancer in Beaumont Hospital now spans from diagnosis, throughout oncological and surgical treatment and into survivorship.  Patients have access to a dietitian in both the outpatient and inpatient setting.  Our role involves providing evidenced based nutritional interventions: we help patients to maximise their nutritional status before treatment, support them with advice and nutritional interventions during treatment and surgery and advise on best dietary strategies to use to adjust to life after surgery and into the longer term. The dietetic team work closely with the other members of the Upper GI Multidisciplinary Team to develop the service and improve patient experiences and outcomes.  In 2023 Cathy was a key speaker at an Oesophageal Cancer Fund (OCF) Patient Support Meeting and the dietetic team have led research and audit presented both nationally and internationally on nutrition and Upper GI cancer over the last number of years.

My name is Orla Brett and I am a Physician Associate in Beaumont Hospital. I commenced this role as part of the upper GI surgical team in 2019, having completed my MSc in Physician Associate Studies in RCSI, Dublin. I have been working in this specialty for almost 5 years, which has absolutely flown by. My role has established and evolved over the years involving a variety of tasks and responsibilities. I am trained as a robotic first assistant for major UGI surgeries including oesophagectomy and gastrectomy for our cancer patients. I assess, manage and follow up patients in our surgical outpatient department with support from my supervising consultant, Mr Robb. I liaise with patients in their peri-operative phase, communicating with GPs and other necessary hospital specialties. I believe I have become an integral part of upper GI team and a point of contact for staff, students and patients. I enjoy being a familiar face to our patient’s who are often seen by our service for over 5 years for cancer surveillance. I take pride in helping our new team during NCHD changeover by providing continuity of care within our service. Navigating a new role in the healthcare system can have it’s challenges, however, I am delighted with how my role has evolved as a physician associate on the upper GI team and hope I continue to provide continuity going forward. 

My name is Professor Danny Cheriyan, and I’m a Consultant Gastroenterologist in Beaumont Hospital. I work in all areas of gastroenterology but I have a special interest in advanced endoscopy. One of the procedures that I’m particularly interested in is Endoscopic Submucosal Dissection (ESD).

ESD is a minimally invasive endoscopic procedure that is performed under general anaesthesia. I use a flexible tube called an endoscope to see and treat early cancers of the upper gastrointestinal tract (oesophagus and stomach). This procedure allows for a lesion to be removed in one piece, without the need for removing a large part of the oesophagus or stomach. This results in a much shorter procedure, shorter length of stay in hospital (typically 1 day), and a much easier recovery for the patient (compared to major surgery, which involves a 12 to 14 inpatient stay). Most importantly, patients have their natural anatomy intact after the procedure.

Beaumont Hospital is currently the only hospital in the country performing ESD. We began this procedure 2 years ago and have performed it successfully on over 30 patients. To further advance our skills and patient care, I will be undertaking a short sabbatical in Japan this year, to train further and gain more experience with this advanced technique.

Cancer Research covers a broad spectrum from prevention to treatment and beyond. Making sure patient perspectives and experience guide the research agenda means that it has more value and relevance for patients as well as making it more meaningful for researchers. Members of The Cancer Patient Partnership Working Group (CPPWG) joined researchers in the RCSI lab in St Stephens Green who are looking into treatments for metastatic breast cancer,  It was an very informative and enjoyable visit allowing us to see how lab based research is carried out and to ask questions and to exchange ideas with the researchers. 

Anne Mynes – Patient Partner and Co-Chair of the CPPWG, “For me, the visit to the lab was a mixture of nostalgia for my early days in research in the 1980s, pride in seeing our young women actively investing their time in science and research , and hope that this investment will lead to better outcomes for all cancer patients.”

Vicky Lunt – Principal Clinical Psychologist – “I left the lab feeling reassured that there are world class trials ongoing in Ireland.  I am not sure how many people are aware of just how much passion and focus goes into the work of these researchers.” Vanessa Fay- Patient Partner. “My experience was that I was amazed by the level of research that was going on behind the scenes. As a former patient it was very comforting seeing that there were teams of people working on potential treatments right here in Dublin. It was fascinating to see the imagery on screen. Cancer treatment is simplified from doctor to patient. Take this medicine and you will get better… maybe… But seeing this gave me more faith in the treatments we are prescribed.” 

Victoria and Vanessa

Dr Petra Jagušt PhD, Irish Cancer Society Research Fellow – “The Endocrine Oncology Research Group puts patients at the centre of the research and it was our pleasure to host the Cancer Patient Partner Working Group (CPPWG) at RCSI. This visit was a great opportunity to hear patients’ experiences and insights which I am looking forward to including in my future research. The CPPWG visit has given me a new sense of perspective and reinforced my drive to make a difference. I am looking forward to our future collaborations.”

Louise, Aobhinn, Petra

 Louise Watson and Aoibhin Powell, PhD Students: “We really enjoyed the visit. It was a great opportunity to demonstrate some of the research we do in the lab. We had some very engaging discussions about our research and the impact that it can have. It was a privilege to gain a deeper insight into the vital role of patients in research and the importance of the connection between researchers and patients. “

My name is Laura Kiernan and I work as a Clinical Nurse Specialist (CNS) in Haematology. The main focus of my CNS role is to provide support and education for patients with a new diagnosis or relapsed haematological malignancy (blood cancer), such as Multiple Myeloma, Leukaemia or Lymphoma.

Throughout 2023, I reviewed 205 patients who were commencing treatment in the Haematology Oncology Ward. Some I met with their family before commencing treatment, others I managed to meet on the day of starting treatment – with or without their family. I provide patients with both verbal and written education about their diagnosis, planned treatment schedule and side effects. I also provide them with information about support services within the hospital and in the community and made any relevant referrals at this time.

In September 2023 I decided to ask patients about their experience of how they received information, to find out if attending a pre treatment clinic with a specialist nurse would be of benefit to them. I presented my idea to the Cancer Patient Partnership Working Group. This is a group of patient partners and staff who work together on various on projects. They gave me great advice on the type of questions to ask  in my survey and on changes I should make so it was easier to read and understand.

I sent out 30 surveys and received 19 back. The feedback was very positive, with an overwhelming agreement that meeting a CNS at the beginning of treatment alleviated anxiety and allowed time for questions. Most agreed that a dedicated, separate appointment to meet a CNS before treatment begins would be beneficial. There were also some other suggestions that I had not considered, and this has helped me to plan other improvements of the service I provide. These include:

• Develop a pre-treatment nurse specialist clinic – This clinic will be held on a date before treatment and will be used to provide education about the drugs, side effects and support services available for patients and their family. Referrals to appropriate teams members will be made. Ideally at this appointment, patients could have any outstanding tests performed, and any prescriptions provided to them, to minimize stress on the first treatment day.
• Develop an End of treatment summary – This is something that came up as part of the feedback. Patients said that when they finish treatment it can be hard to remember all the details of the treatment they had. I plan to develop a treatment summary’ document that can be given to patients.
• Add a follow up call to the patient plan of care – The majority of patients were in agreement that a follow up phone call with the CNS they had met, either 1 week, or 1 month after commencing treatment would be of benefit. It is at these times that new questions are formed, that weren’t asked at the beginning, or even new symptoms appear, and patients need additional advice and support. Referrals that were declined at the initial stages might actually be relevant at this stage also.

You can read a copy of the results from the survey by Click Here