Chemotherapy for penile cancer

Chemotherapy (often called chemo) is the use of drugs to treat cancer. Two types of chemotherapy that may be used in treating penile cancer are topical chemotherapy and systemic chemotherapy.

Topical chemotherapy

Topical chemotherapy means that an anti-cancer medicine is placed directly onto the skin instead of being taken as a pill or injected into a vein. The drug most often used in topical treatment of penile cancer is 5-fluorouracil (5-FU), which is applied daily for several weeks.

When applied directly onto the skin in the form of a cream, 5-FU reaches cancer cells near the skin surface but cannot reach cancer cells that have invaded deeply into the skin or spread to other organs. For this reason, treatment with 5-FU generally is used only for pre-cancerous conditions or carcinoma in situ (Tis, stage 0).

Because the drug does not spread throughout the body, the side effects that often occur with systemic chemotherapy do not occur with topical chemotherapy. Treatment with 5-FU cream causes the treated skin to become red and very sensitive for a few weeks. Using other topical medicines or creams can help relieve this.

Systemic chemotherapy

Systemic chemo uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream to reach cancer cells in all areas of the body. This treatment is useful for cancers that have spread to lymph nodes or distant organs. Chemo can also be used to shrink cancers before surgery to make them easier to remove. It is also being studied to see if giving it after surgery will keep the cancer from coming back and improve survival.

Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Some of the drugs most commonly used to treat penile cancer include:

• Cisplatin
• Fluorouracil (5-FU)
• Methotrexate (MTX)
• Bleomycin
• Paclitaxel (Taxol®)
• Ifosfamide (Ifex®, ifos)

Often, these drugs are used together to treat penile cancer that has spread to lymph nodes or other organs. The most commonly used combinations include:

• BMP: bleomycin, methotrexate, and cisplatin ("platinum")
• TIP: paclitaxel (Taxol), ifosfamide, and cisplatin ("platinum")

Possible side effects: Chemotherapy drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, divide quickly, too. These cells are also likely to be affected by chemotherapy, which can lead to some side effects.

The side effects of chemotherapy depend on the type and dose of drugs you take and how long they are used. Common side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Low blood counts

Chemo drugs can affect the blood forming cells of the bone marrow. This can lead to:

• Increased chance of infections (due to low white blood cell counts)
• Easy bruising or bleeding (due to low blood platelet counts)
• Fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

Some of the drugs used to treat penile cancer can have specific side effects.

• Cisplatin can cause nerve damage (neuropathy) and kidney damage (nephropathy). The nerve damage can cause problems with numbness and tingling in the hands and feet. Doctors give a lot of intravenous (IV) fluid with cisplatin to help prevent the kidney damage.
• 5-fluorouracil (5-FU) can cause sores in the mouth (mucositis) that can make it hard to eat. This drug can also cause diarrhea.
• Vincristine and paclitaxel can also cause nerve damage.
• A rare side effect of bleomycin is lung damage, which can lead to problems breathing. The risk of this is higher in patients who smoke.
• Ifosfamide can damage the lining of the bladder (called hemorrhagic cystitis). A drug called mesna is often given with ifosfamide to prevent this problem.