Radiotherapy for localised penile cancer

Radiotherapy (localised penile cancer)

Radiation therapy is the use of high-energy x-rays to kill cancer cells and these can be directed at cancer from outside of the body (external beam radiotherapy) or from within the body (brachytherapy). Both types of radiotherapy can be used to treat penile cancer which is confined to the penis as an alternative to surgery.

External beam radiotherapy

External beam radiotherapy can also sometimes be used to treat other areas of the body that may have been affected by penile cancer.

Before both of these types of radiotherapy are performed the area to be treated will be thoroughly identified by performing scans such as CT and MRI  and ink marks applied to the target treatment area.
Men will need to be circumcised (the foreskin surgically removed) prior to radiotherapy to reduce the chance of skin swelling and irritation which may affect the penis as a result of treatment.

Brachytherapy

This type of treatment can be used to treat penile cancer which is not greater than 4cm in size and can be performed using two possible methods.
Under a general anaesethic radioactive needles are positioned through the penis and small radioactive pellets inserted near to the cancerous areas. The needles will need to stay in place for up to 7 days and men will have to stay in hospital during this time in a room with limited mobility (bed rest). Children and pregnant women will not be allowed to visit them. The needles and the catheter will be removed under a general anesthetic once all the treatment has been given.
To protect the passage of urine from the bladder a urinary catheter will be inserted.

Plesiobrachytherapy

A special plastic mould is made in the shape of the penis. This can be fitted over the penis and small radioactive wires attached to the
penile tissue around the cancerous area. Radiation can then be administered through the wires. This type of treatment can be performed on a daily basis over several days.

External beam radiotherapy

This treatment involves radiation being beamed at cancer by an external machine.
Treatment tends to be given over a six week period in short doses (10-15 minutes). Beams of radiation are directed at the cancer and
the dose of radiotherapy given is controlled by a computer.

Side effects related to radiotherapy treatment

Fatigue

This may be caused by a combination of both treatment and travel. Getting small restful naps or taking a mild sedative medication may help.

Skin reactions

Radiotherapy can irritate the sensitive skin around the penis and the blood supply to the penis may be reduced. These symptoms tend to occur 2-3 weeks from starting external beam radiotherapy and 2-3 weeks after brachytherapy.
Vitamin E supplements and topical creams can help the healing process and these may be prescribed by the healthcare team. It is also advisable to keep areas that have been exposed to radiotherapy covered and protected from direct sunlight.

Problems passing urine

Radiotherapy can sometimes cause the tissue of the penis to become thicker and this can sometimes cause a narrowing or ‘stricture’ of the urethra and cause the urinary stream to spray. If this occurs, a minor operation can sometimes be performed to widen the urethra.
Men can also be taught how to widen the urethra using specially designed plastic tubes (urethral dilatation).
There are also several types of disposable urinary funnel which can be purchased (see diagram below). Examples of these can be found on amazon.co.uk. Similar non-disposable devices are available on prescription and men should ask their GP or Practice nurse for details of these.

It is also possible to purchase a special key (RADAR Key) which allows anyone with a medical condition which has affected their urinary pattern to make use of otherwise locked or inaccessible toilets in the UK. It can be ordered from Disability Rights for a small fee. (https://crm.disabilityrightsuk.org/ radar-nks-key or 020 7250 8191).
A free ‘Just Cant Wait’ toilet card can also be obtained from the Bladder and Bowel Foundation  which is universally recognised and may allow men access to toilets in the same way. (https:// www.bladderandbowelfoundation.org/ just-cant-wait-card-introduction / or 01926 357220)

You can also download The Bladder & Bowel Community app, designed to give you quick and easy access to a mobile version of the original Just Can’t Wait toilet card. https://itunes.apple.com/gb/app/bladder-bowel-community/id1164911135

To read more about possible side effects of radiotherapy and how to manage them from NHS Choices please click here

To read personal stories of men who have been affected and treated for penile cancer please click here

Updated 26/7/17 Next review January 2018.

 

References available on request.

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