Radiotherapy and chemotherapy for advanced penile cancer

Radiotherapy and chemotherapy can be used to treat penile cancer which has spread to other areas of the body such as lymph nodes or other organs. This is called metastatic disease.

External beam radiotherapy

External beam radiotherapy (radiotherapy from outside the body) directs radiation at cancer. It can shrink areas of cancer which are affecting certain parts of the body and help provide relief from symptoms such as pain or discomfort.

Common side effects of radiotherapy

Skin reactions	Radiotherapy can irritate the skin These symptoms may occur 2-3 weeks after treatment. 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. Treated areas may turn a slightly darker colour temporarily.
Fatigue	This may be caused by a combination of treatment and travel. Getting small restful naps or taking a mild sedative medication may help.
Feeling sick (nausea)	Anti-sickness medication can be prescribed to help stop nausea.
Diarrhoea	Reducing your intake of high fibre food may help (fruit, vegetables, wholewheat products). Drinking plenty of fluids will help reduce the risk of dehydration.
Lymphoedema	Lymphoedema occurs when lymph fluid accumulates in the groin area and prevents adequate drainage to the lower body (usually the legs and scrotum). This can cause swelling. Lymphoedema is treated by a specialist team of healthcare professionals. For more information on lymphoedema please click here.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It is administered directly into the blood stream. During and after chemotherapy treatment scans and regular blood tests will be performed to assess your response to treatment and monitor any side affects you may experience.

Chemotherapy effects

Before starting chemotherapy, you may need to have a hearing test (audiogram) because chemotherapy can affect hearing, and a breathing test as some chemotherapy can reduce lung function. Chemotherapy may cause infertility which can be reversible, so you will be advised to store sperm (sperm banking) before commencing treatment. You will also be advised to avoid fathering a child for a period during and after chemotherapy. The effects of chemotherapy may last for some time after treatment from a few months to a year or more. You may feel tired or exhausted and this should be taken account when considering going back to work or if you have a busy lifestyle. Exercise may be difficult but, if possible, you should maintain this as much as possible. Loss of muscle strength can occur quite quickly if you are inactive – exercise helps prevent this.  

Managing common side effects of chemotherapy
Infection	Chemotherapy reduces your white blood cell count (white blood cells fight infection). Contact your doctor or medical team as soon as possible if you have a fever, chills, or cough or feel as if you have a bad cold. If you get an infection, you might need antibiotics to treat it. You should pay special attention to your personal hygiene.
Tiredness	Feeling tired during and after treatment is common and will usually pass after a few days. Staying active can help. Some people find benefit in meditating. Sleeping tablets can be prescribed if you can’t sleep.
Upset stomach (nausea)	Chemotherapy and radiation therapy can upset your stomach or make you lose your appetite. Tell your doctor or nurse if this happens. Anti-nausea medicine can help calm your stomach. If you do not feel like eating, a high-calorie food supplements can provide nutrition. A hospital dietician may be able to help manage your diet. Ginger-ale or tea, or biscuits (eaten regularly throughout the day), may help reduce nausea. Peppermint tea may reduce nausea but always drink slowly taking lots of sips. A small meal a few hours before chemotherapy may help reduce nausea. Avoid Hot and spicy foods (curry, Cajun cooking etc.). Foods with high sugar content. Fatty and greasy foods (chips, burgers etc.). Large meals Eating and drinking too fast and drinking with meals. Alcohol Caffeine which is found in tea/coffee, chocolate bars and energy drinks. Baby food-this is designed for babies and has very little nutrition for adults.
Taste	Chemotherapy can cause a metallic taste. The following may help. Fresh pineapple or other sharp-tasting fruit. Seasoned or marinated food for meals to add flavour. Use herbs in cooking to add a stronger taste.
Mouth Sores	Fresh pineapple can help prevent and heal mouth ulcers by stimulating saliva which protects the mouth. Bonjela or similar healing gels. Soft child’s/baby bristle toothbrush and baby/ soothing (for instance) aloe vera toothpaste. Soft puréed or liquid diet to prevent chewing. Rinse the mouth with salt water on a regular basis if it can be tolerated; up to 4-5 times a day. Sucking crushed ice during treatment. Artificial saliva which can be prescribed by a doctor. Vaseline for lips.
Diarrhoea	Treatment can affect your bowel function. Diarrhoea can be managed with anti-diarrhoea medicine. A low-fibre diet (reduce fruit, vegetables, wholewheat products) can also help.
Skin changes	Chemotherapy can cause changes in your skin and nails. Symptoms will usually go away after treatment is finished. Chemotherapy can make your skin temporarily more sensitive to sunlight and you will need to use a high factor sunscreen (30+) if you are at risk of being exposed to strong sunlight.
Hair Loss	You may experience hair loss after 1 or 2 weeks of treatment. It should start to regrow around 3-6 months after chemotherapy has finished. Wearing a baseball cap or shaving all your hair off when it starts to fall out may make you feel more confident. can reduce the effectiveness of the chemo.
Tinnitus (Ringing in the ears)	Listening to gentle background music may help. Ask people to speak clearly and slowly
Tingling in arms (peripheral neuropathy)	Keep hands and feet warm and avoid extremes of temperature. Take care when preparing food (use gloves) or when running hot water (test with an elbow) to prevent the risk of burning. Gentle exercise.

Following radiotherapy or chemotherapy, the medical team will review you in hospital on a regular basis with further scans and blood tests.

Reviewed November 2023