External radiotherapy for penile cancer
Radiotherapy uses high energy x-rays to treat penile cancer cells. You have the treatment in a hospital radiotherapy department.
External radiotherapy destroys cancer cells using radiation aimed at the cancer from a machine. You usually have it as an outpatient each weekday over 4 to 6 weeks.
Some hospitals have rooms near the hospital you can stay in if you have a long way to travel.
You go to the radiotherapy department from your ward if you’re already in hospital.
When you might have radiotherapy
Surgery is usually the main treatment for penile cancer. You might have radiotherapy for the following reasons:
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instead of surgery if you are unable to have or do not want to have an operation
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instead of surgery to lymph nodes in the groin
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after surgery if there is a risk that cancer cells are left in the groin
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to treat the lymph nodes in the pelvis if there is a high risk of the cancer coming back
Radiotherapy and chemotherapy together (chemoradiotherapy) have been used in research studies, but further studies are necessary.
Radiotherapy to relieve symptoms
You might have radiotherapy to relieve symptoms if penile cancer has spread. This is called palliative radiotherapy. Radiotherapy can shrink the cancer for a period of time and relieve symptoms.
You usually have a short course of daily treatments to the affected area, over a few days.
Internal radiotherapy
Some people have internal radiotherapy. This is also called brachytherapy. This is when the doctor puts thin radiotherapy tubes or wires on, or inside the penis, close to the tumour.
Before you have treatment
You might have a circumcision (removal of the foreskin) before you have radiotherapy. Radiotherapy treatment may cause swelling and inflammation of the penis. Removing the foreskin prevents any problems.
The radiotherapy room
Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position. Or it might rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.
Before your first treatment, your 
will explain what you will see and hear. In some departments, the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.
Before each treatment session
The radiographers help you to get into position on the treatment couch. You might have wax or a plastic box put on to your penis to hold it away from your body during treatment. It helps to make sure that:
- your penis doesn't move during treatment
- the correct amount of radiotherapy reaches the target area
They line up the radiotherapy machine. They use the marks on your skin to help, if you have them from your radiotherapy planning. Then the radiographers leave you alone in the room for a few minutes.
During the treatment
You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment. This is to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.
Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.
The following is a video about radiotherapy for cancer in general.
Dan (radiographer): Before your treatment starts your doctor will need to work out exactly where the treatment needs to go and also which parts need to be avoided by the treatment. To have radiotherapy you lie in the same position as you did for your planning scans. We then line up the machine based on your tattoo marks. It is really important that you stay very, very still when you are having treatment it is also important to let the radiographers know right at the beginning if you are not comfortable so they can adjust your position
Radiographer: Ok all done, we’ll be back in a couple of minutes
Dan (radiographer): We leave the room and control the room from a separate room This is so we aren’t exposed to radiation. Treatment takes a few minutes and you will be able to talk to us using an intercom. We can see and hear you while you are having your treatment and will check that you are ok. When your treatment starts you won’t feel anything; you may hear the machine as it moves around you giving the treatment from different angles. Because we are aiming to give the same treatment to the same part of the body everyday then the treatment process is exactly the same everyday so you shouldn’t notice any difference. You’ll see someone from the team caring for you once a week while you are having treatment they’ll ask how you are and about any side effects.
Patient: They get you from one sitting area to another and then take you into the room where you undress to the waist and then lie down and line you up by either moving you or asking you to shuffle a little and they check the dimensions and they talk to one another and they say I am fine this side how are you ...yes fine...ok, stay where you are Jeff and that was it. There were a few little clicks and lights go on and off and you can see a green laser beam which lines up with certain things on your body uh so no, no real noise and no discomfort .
You won't be radioactive
This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Travelling to radiotherapy appointments
You might have to travel a long way each day for your radiotherapy. This depends on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask your radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7 am till 9 pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or discounted parking. They may be able to give you tips on free places to park nearby.
Hospital transport may be available if you have no other way to get to the hospital. But it might not always be at convenient times. It is usually for people who struggle to use public transport. Or who have any other illnesses or disabilities. You might need to arrange hospital transport yourself.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this and hospital transport.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
Side effects of treatment
Radiotherapy to the penis can make you tired. Your penis may become swollen and may become sore.
