Penile Cancer

Additional treatments

Surgery is currently the main treatment for penile cancer (see Types of surgery for penile cancer), although other treatments have been used in the past. Surgery is used because it appears to be the most effective treatment for men with cancer of the penis. Radiotherapy (the use of high energy rays to destroy cancer cells) may be used in rare cases where surgery is not an option, or in addition to surgery where the cancer has spread to the lymph nodes in the groin, or to treat symptoms such as pain where the cancer has spread to other parts of the body. Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells and is only rarely used as a main treatment for penile cancer. If you have an small early stage cancer on the foreskin or end of the penis chemotherapy cream can be used – this only kills the cancer cells near the surface of the skin so is not suitable to treat deeper cancers. While advanced or metastatic penile cancer is rare, chemotherapy into a vein can help to slow the growth of cancer around the body. Research is also investigating using chemotherapy before surgery (neo adjuvant) to reduce the amount of surgery needed and after surgery (adjuvant therapy) to reduce the risk of the cancer coming back.
 
Surgical removal of the cancer is usually straightforward, but occasionally can be a complicated procedure that affects urination (peeing). Rarely, an additional operation may be required to the waterworks. Occasionally, the cancer may return in the penis and a second operation is required. The lymph nodes in the groin and stomach (or ‘abdomen’) may also become cancerous and require treatment (see ‘Lymph node removal).
Most men said that they had been told that surgery was the main treatment and were happy to follow their consultant’s recommendation. Some said that radiotherapy or chemotherapy had been mentioned in passing but usually as an addition to surgery not an alternative. Some had asked about these treatments but were told they were inappropriate for their cancer. Others had been surprised that these treatments had not been offered as they had assumed they were standard treatments for cancer.
Chemotherapy, radiotherapy or a combination of the two was given to some of the men who had been treated in the 1990s or earlier. James had been offered radiotherapy as an alternative to surgery but chose the operation. John Z didn’t want to lose part or all of his penis and persuaded his doctors to treat him with radiotherapy after hearing that this treatment was used in France.
Before having radiotherapy to the penis, the men had a mould made to hold their penis in position during treatment and had small ink dots marked on their skin (tattoos) for accurate positioning of the radiotherapy machine. Treatment lasts only a few minutes and was typically administered five days each week for four to six weeks. Radiotherapy treatment to the lymph nodes is rarely used but also involves treatment for five days per week over three to four weeks.
Chemotherapy and radiotherapy may produce side effects since normal tissues can be damaged as well as the cancer cells. Side effects experienced by the men we spoke to included dry and peeling skin, soreness, infections, tiredness, loose bowel motions, and lymphoedema in the legs, scrotum and remaining penis. Lymphoedema is a build-up of fluid caused by damage to the lymph nodes, which are small oval shaped balls found throughout the body including the armpit, neck and groin. Most side effects of treatment disappear within a few weeks of treatment finishing, but others, such as lymphoedema, may not disappear completely. However there are things that can be done to help reduce the swelling and discomfort of lymphoedema, and men with this are often referred to a lymphoedema specialist for advice.
Men treated for penile cancer in the 1990s may have had other treatments. For instance, John tried a biological therapy called Interferon Alpha, which stimulates the immune system to fight cancer. Biological therapies are not currently used for penile cancer but may be used as part of research trials.
Some of the men had known friends or family members having either chemotherapy or radiotherapy for other types of cancer and had been put off these forms of treatment by their experiences. After surgery, John Z discussed chemotherapy with a Macmillan nurse but because he’d seen how sick ‘chemo’ had made his friend he decided that he’d rather let the cancer run its course. James chose surgery because his treatment would be over in one go, whereas radiotherapy would have required weeks of appointments.

Last reviewed January 2015.
Last updated January 2015.

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