Penile Cancer: Chemotherapy

Chemotherapy (chemo) uses strong medicines to kill cancer cells. The medicines travel all through your body in your blood. They attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemo can harm those cells. This can cause side effects.

Chemo might be part of the treatment for penile cancer in any of these cases:

• If you have very early-stage penile cancer. In this case, chemo might be a cream that's put right on the skin. This is called  topical chemotherapy.

• If penile cancer has grown too big to be removed by surgery or has spread to nearby lymph nodes. This is done to try to shrink the cancer so it can be removed. It's called neoadjuvant therapy.

• If penile cancer has spread to lymph nodes or to other parts of the body. Sometimes chemo is given along with radiation therapy. This is called chemoradiation.

• After surgery, if cancer was found in a lymph node. It can kill any cancer cells that might be left in your body. This can help keep the cancer from coming back and can help you live longer. This is called adjuvant therapy.

Chemotherapy is being studied in clinical trials. Research tries to find the best treatment medicines and regimens to use at specific times during treatment.

Before treatment starts, you will meet with a medical oncologist. This is a healthcare provider with special training to treat cancer with medicines like chemo. The healthcare provider will discuss your treatment choices with you and tell you what you might expect.

Chemo for penile cancer can be given in either of these ways: 

• Systemic chemotherapy. With this, you get chemo as an injection by IV (intravenously) into a vein or as a pill to swallow. The medicines travel in your blood, killing cancer cells all over your body. Systemic chemo can reach cancer that may have spread deeply into your skin or to other parts of your body. 

• Topical chemotherapy. For this, you put a cream on the skin of your penis. It can kill cancer cells near the surface of your skin. But it can't reach cancer cells that are deep in your skin or those that have spread to other organs. You will be told how to apply the cream, how often to apply it, and for how many weeks.

You usually get systemic chemo as an outpatient. This means you get it at a hospital, clinic, or healthcare provider's office. You go home the same day. You'll be watched for reactions during your treatments. Each treatment may last for a while, so you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemo is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles usually last 3 or 4 weeks. Your healthcare provider will discuss your chemo schedule with you.

Some of the chemo medicines used to treat penile cancer include:

• Cisplatin

• Fluorouracil (5-FU)

• Ifosfamide

• Mitomycin C

• Paclitaxel

Most of the time, two or more of these medicines are used together.

For topical chemotherapy, fluorouracil is available as a cream. It is usually applied to the penis twice daily for 2 to 6 weeks. Your healthcare provider will instruct you. Another topical creamcalled imiquimod may be used. It works with your immune system to treat the penile lesions.

Side effects of chemo are different for each person. They vary based on the medicines and dose you get. Ask your healthcare provider or chemotherapy nurse for details about the side effects of the medicines you're getting. Be sure to tell them about any changes you notice during treatment.

Some of the most common side effects of chemo for penile cancer include:

• Hair loss

• Nausea and vomiting

• Mouth sores

• Diarrhea

• Loss of appetite or changes in the way things taste

• Extreme tiredness (fatigue)

Other common side effects are because chemo decreases your blood counts:

• A decrease in white blood cells puts you at a higher risk for infections. If you have a fever during chemo, tell your healthcare provider right away.
• A decrease in platelets puts you at risk for bleeding. Tell your healthcare provider about any bleeding or easy bruising you have during chemo.
• A decrease in red blood cells causes fatigue, weakness, and a lack of energy.

Some other side effects are linked to certain chemo medicines. For instance, cisplatin and paclitaxel can cause nerve damage (peripheral neuropathy). This can lead to pain, tingling, and numbness in the hands and feet.

Many chemo side effects can be treated to keep them from getting worse. There may even be things you can do to help prevent some of them. Most side effects go away over time after treatment ends. But some can last longer or be permanent. Ask your healthcare team what side effects you should expect.

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work, and what side effects they might cause.

Talk with your healthcare providers about what symptoms to watch for and when to call them. For instance, chemo can make you more likely to get infections. You may be told to check your temperature and stay away from people who are sick. You may need to call if you have a fever or chills. Make sure you know what number to call with questions. Is there a different number for evenings, weekends, or holidays when the office is closed?

It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.