Side effects of radiotherapy for penile cancer

Short term side effects from radiotherapy usually begin during your treatment course and gradually get better over 1 to 3 weeks after the treatment has finished. The possible side effects are

• Tiredness
• Sore skin
• Swelling

Tiredness

You may find you become more and more tired as your treatment goes on. This is very common with radiotherapy. It is caused partly by the travelling back and forth to hospital, and partly by the treatment itself.

Don’t be afraid to rest if you feel you need to. It is good to try and get some exercise each day, however gentle. But if you feel like you want to have a lie down, then you probably need to do just that. There is more information about coping with tiredness in the cancer fatigue section.

Sore skin

Radiotherapy can make your skin sore. The skin round the penis is very sensitive and can get quite sore during radiotherapy treatment. Tell your nurse, doctor or radiographer if your skin starts to break down, you have any discharge, or an ulcer forms. If this happens, your skin could get infected.

Washing can make the soreness worse. You should only wash the area with plain water and simple soaps, such as baby soap. Gently pat the skin dry with a soft towel - don’t rub it. Avoid perfumed or medicated soaps, creams or anything that you haven't first discussed with your specialist, radiotherapy nurse, or radiographer.

Don’t forget to ask for advice from the radiotherapy nurse. And remember, the soreness will get better after your treatment is over.

Swelling

Your penis may become swollen and inflamed. This swelling can cause pain. Tell your doctor, nurse or radiographer if you have pain so that they can give you painkillers. The swelling will go down when you finish treatment.

As well as short term side effects while you are having treatment, radiotherapy can cause long term side effects in some people. Your doctor will make every effort to make sure you have as few side effects as possible. But some people are more sensitive than others to radiation. At the moment, doctors can’t tell who is and who isn’t particularly sensitive before they give radiotherapy.

Long term side effects are more likely with higher doses of radiation. So if you are having a short course of radiotherapy to help with symptoms, you are unlikely to have long term effects.

Only some people treated will have long term effects. They come on between a few months and a couple of years after your course of treatment. Any side effects will depend on where you have had the radiotherapy. For example, if you had radiotherapy to your pelvis, you might develop bladder problems.

Radiotherapy to the penis may cause the following

• Difficulty in passing urine
• Reduced blood supply to the penis
• Difficulty in getting an erection
• Swelling of your legs or abdomen

Difficulty in passing urine

After radiotherapy to the penis you can get narrowing of the urethra, making passing urine very difficult and sometimes impossible. Doctors call this a stricture. This happens if the tissue inside the penis becomes thicker (fibrosis). Tell your doctor or nurse if you start to have any difficulty in passing urine. You may need to have your urethra stretched (dilated). Or you may have surgery to widen the urethra.

Reduced blood supply to the penis

Radiotherapy can sometimes damage the blood supply to the treated area. This can lead to problems keeping the tissue healthy. The tissue may become starved of oxygen and the nutrients it needs. If you notice any changes in the colour of your skin where you had treatment, let your doctor know.

Difficulty in getting an erection

Most men are able to have sex after they've recovered from a course of radiotherapy. But if you develop any thickening of the skin, or a reduced blood supply to the penis, getting an erection might be more difficult. Tell your doctor if you are having any problems. There is more information about problems getting an erection in the sex, sexuality and cancer section.

Swelling of your legs or abdomen

Some men develop swelling in their legs and in the lower part of their body after radiotherapy to the lymph nodes in the groin and pelvis. This swelling is called lymphoedema (lim-fo-dee-ma). There is more chance that this will happen if you've had both surgery and radiotherapy to the area. This is a difficult side effect to live with.

Lymphoedema can be painful and tiring. It may affect one leg or both legs. If you do notice any redness, pain or swelling, it is important to tell your doctor about this straight away. Lymphoedema is easiest to control if it is caught early. It is important for you to see a lymphoedema specialist if you have signs of swelling. This is usually a nurse or physiotherapist. The British Lymphology Society have a register of UK lymphoedema practitioners.

Specially fitted support stockings may help. If you have too much swelling for support stockings, your specialist may suggest elastic bandages to try to reduce it. This is called compression bandaging. Some types of massage can also help, particularly manual lymphatic drainage (MLD). Some specialists use inflatable sleeves to gently squeeze fluid up towards the top of your legs so that it can drain away through the lymphatic vessels. These tiny tubes carry tissue fluid around the body and empty it back into the bloodstream.

Lymphoedema can come on years after your treatment. To help prevent it, you should try to prevent infections. Having an infection leads to local swelling. This can start lymphoedema off if you have had surgery or radiotherapy to your lymph nodes. It is a good idea to

• Try to protect your legs and feet from sharp objects - for example, don't walk around with bare feet, and wear long trousers for gardening
• Wear insect repellent so that you won't get bitten
• Take care of all cuts, scratches or bites without delay, by cleaning with antiseptic and covering with a dressing
• Avoid sunburn
• Take extra care when cutting your toenails - you should not cut or tear the cuticles

Look at the radiotherapy section for more general information about radiotherapy and side effects. This section includes some information about long term side effects.