Chemotherapy is the use of drugs for treating 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 anticancer medicine is placed directly onto the skin rather than being given by mouth or injected into a vein. The drug most often used in topical treatment of penile cancer is 5-fluorouracil (5-FU).

When applied directly onto the skin in the form of a topical cream, 5-FU reaches cancer cells near the skin surface but does not 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 premalignant conditions or carcinoma in situ (Tis, stage 0).

One of its main advantages is that the drug does not spread throughout the body. Therefore, the side effects to other organs that can occur with systemic chemotherapy (treatment that affects the whole body) do not occur with topical chemotherapy. After treatment, a biopsy is done. If cancer remains, surgery is recommended.

Treatment with 5-FU cream causes the treated skin to be red and sensitive for a few weeks. Use of other topical medicines or creams can help relieve these side effects.

Systemic chemotherapy: Systemic chemotherapy uses anticancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for cancers that have spread (metastasized) to distant organs. In contrast to topical chemotherapy, systemic chemotherapy can attack cancer cells that have spread beyond the penis to lymph nodes and other organs.

One or more chemotherapy drugs may be used to treat penile cancer that has spread to other organs. Some chemotherapy drugs such as cisplatin, vincristine, methotrexate, and bleomycin can temporarily shrink or delay the spread of advanced penile cancers and relieve some symptoms. These drugs are also being studied as an additional (adjuvant) therapy to prevent or delay cancer recurrence after surgery. Recently a combination of the drugs carboplatin and paclitaxel has proved effective.

Chemotherapy drugs kill cancer cells but also damage some normal cells. Therefore, careful attention must be given to avoid or minimize side effects, which depend on the specific drugs, the amount taken, and the length of treatment. Temporary side effects might include nausea and vomiting, loss of appetite, loss of hair, and mouth sores. Be sure to tell your cancer care team if you are having side effects because they can be prevented or managed.

Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts that can result in:

• increased chance of infection (due to a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets)
• fatigue or shortness of breath (due to low red blood cell counts)

Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends. There are remedies for many of the temporary side effects of chemotherapy, so you should not hesitate to discuss them with your cancer care team. For example, antinausea drugs can be given to prevent or reduce nausea and vomiting. Other drugs can be given to boost the blood cells.

Revised: 05/31/2006