Radiotherapy for cancers of the penis
Your oncologist has recommended that you have a course of radiotherapy to help manage your condition. This page aims to tell you about radiotherapy and what will happen. Please be aware that radiotherapy centres are training centres for doctors, nurses and radiographers, including both male and female members of staff. Students may be present in the department but they are supervised at all times. If you would prefer not to have students present during your treatment please let a member of staff know. You may find it useful to write down some questions before you start your treatment.
Useful contacts
Your healthcare professionals with advise your Radiotherapy appointments, your Radiographers, and Clinical Nurse Specialist.
What is radiotherapy?
Radiotherapy is the use of radiation to treat a disease, most commonly cancer. Radiotherapy is the use of high energy X-rays and other types of radiation, to treat cancer. Radiotherapy itself is painless and does not make you radioactive. It is perfectly safe for you to be with other people, including children and pregnant women, during the course of your treatment.
Your treatment will be divided evenly into a number of sessions (fractions), usually given every other day, Monday to Friday, with weekends off. Weekend treatments may be given around bank holidays or in the event of a machine breakdown.
The treatment delivered will be exactly the same every day. The number of sessions you have will vary depending on a number of factors. For this reason, each patient’s treatment is specially tailored to them, and even those with the same type of cancer as you may receive different treatments.
The treatment will cause damage to the normal cells in the area too, but they can repair themselves much more effectively than the cancer cells. This damage is what causes the side-effects you are likely to experience during the treatment.
The radiotherapy will be delivered by a team of therapeutic radiographers who will see you every day and can answer your questions about radiotherapy, as well as help look after you during your treatment.
You may regularly see other professionals during your treatment, these may include:
- Specialist Therapeutic Radiographers
- Dosimetrists and Medical Physics Experts
- Mould Room Technicians
- Clinical Oncologists
- Oncology Doctors/Registrars
- Clinical Nurse Specialists
- Cancer Support Workers
There is a space at the front of this booklet to write down their contact numbers should you need them.
Planning your treatment
At your planning appointment, and if this has not already been completed, you will be asked to sign a consent form giving your consent to treatment. It is a good idea to bring a list of any questions you may have and an up-todate list of all your medication.
This visit may take up to 1 to 2 hours to complete. As the planning appointments can be quite long, you may wish to bring something to read, eat, and drink. During this appointment you will need to have a scan taken on a machine called a CT (computed tomography) simulator. The scan images will be used to plan your radiotherapy treatment, and are not for diagnostic purposes.
You may or may not also need to visit the ‘Mould Room’ to create a wax ‘block’ of your penis to help with the positioning of your penis during treatment. This will also be used for planning the variation of doses you will require during your treatment. ‘Penile blocks’ can vary and may or may not be required.
The team will work on the best position for you at this appointment. This may mean using immobilisation devices for your head, knees and ankles to keep you in a stable position. Please take painkillers at least 30 minutes before your scan if you think this will make the experience more comfortable.
Once you are in a suitable position the radiographers will take the required CT scans to accurately plan your radiotherapy treatment. The treatment radiographers will replicate this position at each treatment appointment. You may be asked to take a special contrast agent commonly referred to as a dye. This involves inserting a small needle into your vein and injecting the dye. It is used to make specific organs, blood vessels and/or tissue types ‘stand out’, to aid the doctor in planning your treatment.
You should inform the radiographer if you have any allergies, but they will go over this before they use any dye. The most common side-effects of the dye are; a warm or hot “flushed” sensation during the actual injection, the feeling that you need to urinate, and a “metallic” taste in the mouth. This does not last and there is no treatment necessary.
Depending upon your position the radiographer may use a marker to mark your skin. Once the scan has been completed and with your permission, the radiographers may make several small permanent skin marks (tattoos), similar in size to a small freckle on your skin. The points of these marks help correctly position you for each treatment. The consultant and planning technicians then produce an individually designed treatment plan.
Radiotherapy treatment
A team of radiographers will see you at each treatment appointment and will ask how you are feeling. The radiographers work together in the treatment room to position you accurately, moving both yourself and the treatment couch and machine. You will hear them giving each other instructions and information relating to your treatment. You are able to eat and drink before your treatment as normal.
During treatment, the machine will move around you but it will not actually touch you. During treatment it is important for you to stay as still as possible but to breathe normally. Once you are in the correct position the radiographers will leave the room to switch on the machine. The radiographers will be watching you on a closed circuit TV monitor (CCTV) to ensure your safety during the delivery of the radiation. This allows the radiographers to see that you are keeping still and are not experiencing any distress during your treatment. The CCTV camera is not recording or saving any images.
Each session takes approximately 10 to 25 minutes. During this time the radiographers may re-enter the room to adjust your position or move the treatment couch or the machine. Some treatment machines make a highpitched noise when delivering x-rays. This is the only way that you will know that the machine is switched on. You will not feel any pain, heat or any other sensation. The radiotherapy department may sometimes be very busy and your appointment time may be delayed. We will keep you informed of any delays. Your appointments for radiotherapy may not all be at the same time each day and are subject to change. It is possible that during your course of treatment you may miss a day’s treatment due to planned machine maintenance or bank holidays. It is therefore important to speak to a health care professional before booking a holiday immediately following your radiotherapy.
Side-effects of treatment
As your treatment progresses you may experience some side effects. Not everyone will experience all of these effects. Do not worry if you develop any of the following early reactions. They usually begin about halfway through the course of treatment and may last for several weeks after it has finished and then slowly settle down. Please tell the radiographers how you are feeling particularly if your symptoms worsen, so that you can get the care you need.
Early reactions - During or up to 12 weeks after your treatment
Tiredness (fatigue)
Radiotherapy can make you feel more tired than usual, especially if you have to travel a long way. You should try to ‘pace’ yourself, listen to what your body is telling you and try to keep active. Your energy levels may take weeks or months to return to normal.
Skin reaction
The skin on the penis and groin may redden or get darker. It may become dry, flaky and itchy. Towards the end of treatment, your skin may become moist and sore. Sometimes the skin gets very sore and it may blister, break or leak fluid. Your radiographer or nurse will talk to you about how to care for your skin. The penis and scrotum area may become swollen, but this should start to improve 4-6 weeks after treatment finished.
Hair Loss
The hair around the genital area may fall out. Hair may start to fall out 2 or 3 weeks into your radiotherapy treatment. It usually grows back after treatment finishes. Sometimes it grows back with a different texture or colour than it was before. It may take several months to grow back, depending on the dose of radiotherapy you have. Rarely, hair does not grow back or is patchy. Your doctor or radiographer can tell you if this is likely with your treatment.
Problems Passing Urine
Radiotherapy can sometimes cause the tissue of the penis to become thicker and this can cause a narrowing or ‘stricture’ of the urethra. This might cause the urinary stream to spray. If this occurs, a minor operation can sometimes be performed to widen the urethra. A urinary funnel can be prescribed to help control the flow of urine. Speak to your radiographers and nurses for more information.
Later reactions - After 12 weeks after your treatment
Continuing urinary symptoms
Radiotherapy can sometimes cause the tissue of the penis to become thicker and this can cause a narrowing or ‘stricture’ of the urethra, making passing urine more difficult.
Lymphoedema
Lymphoedema occurs when lymph fluid (which flows around the body in one direction) accumulates in the groin area and prevents adequate drainage to the lower extremities (usually the legs). This can cause the leg(s) to swell and can sometimes also affect the penis and scrotum.
Second tumour radiation
In theory, carries a slight risk of causing a second cancer, but this is extremely rare.
Further information
Further information is readily available online. The QR codes below will direct you to further resources relating to your radiotherapy treatment. You can use your smartphone camera to scan the codes or type the full web address into your internet search box.
Orchid- Confidential male cancer helpline
Tel: 0808 802 0010
Website: www.orchid-cancer.org.uk
Macmillan Cancer Support
Website: www.macmillan.org.uk
Cancer Research UK
Website: www.cancerresearchuk.org
Macmillan - Understanding Radiotherapy
The Society and College of Radiographers: Radiotherapy Skin Reactions
Further support will be available locally, please speak to your oncology team who can advise what local charities are there to help you, and what support groups are available near you.
Your data
All personal images and photographs taken during your radiotherapy will be used in accordance with the local Trust policy on the protection and use of patient information.