Supportive care for penile cancer

Supportive care helps with the physical, practical, emotional and spiritual challenges of cancer. This important part of cancer care focuses on improving the quality of life of people with cancer and their loved ones, especially after treatment has ended.

Adjusting to life after treatment is different for everyone. Your recovery will depend on many different factors, such as where the cancer was in your body, the stage of the cancer, the organs and tissues removed during surgery, and the type of treatment and side effects.

If you have been treated for penile cancer, you may have the following concerns.

Self-esteem is how you feel about yourself. Body image is how you see your own body. They are often closely linked. Penile cancer and its treatments can affect your self-esteem and body image. Often this is because cancer or cancer treatments change your body in different ways, such as with:

• scarring
• skin problems
• changes to the shape or size of the penis
• the loss of all or part of the penis
• the loss of the ability to urinate (pee) standing up
• erectile dysfunction
• urinary incontinence

Some of these changes can be temporary. Others can last for a long time or be permanent.

But treatment can affect your self-esteem or body image even if it doesn’t affect how you look. Other people may not be able to see changes to your body, but you may still worry about how they now see you. This can affect your self-esteem, making you feel angry or upset, afraid to go out or worried that others will reject you.

Find out more about coping with body image and self-esteem worries.

Many people continue to have strong, supportive relationships and a satisfying sex life after penile cancer. If sexual problems occur because of penile cancer treatment, there are ways to manage them.

How much penile cancer affects your sex life and sexuality depends on the stage of cancer and which treatments you have. Your doctor will try to offer you the treatment that keeps as much of your penis as possible (called an organ-sparing approach).

If the cancer is found at an early stage, the treatment you have usually won’t affect your ability to have an erection and penetrative sex. Most people are able to carry on with their sex life as before.

If the cancer is found at a more advanced stage, the surgeon may need to remove part or all of your penis (called a partial or total penectomy).

After a partial penectomy, it’s still possible to have an erection and there is often enough of the penis left for penetration during sex. You may have difficulty having an erection (called erectile dysfunction) after treatment but it’s usually temporary.

After a total penectomy, you’ll no longer be able to have erections or have penetrative sex. You may need to explore new ways of expressing your sexuality. If the cancer does not return after treatment, you may be able to have reconstructive surgery that allows for penetration during sex. But, even if this option isn’t available to you, there are still other ways to experience pleasure and enjoy a fulfilling sex life without penetration.

You may lose interest in sex due to side effects from treatment. Talking to a counsellor can help you and your partner talk more openly about sex and explore other approaches to sexual satisfaction.

Find out more about sex and intimacy and sexual problems.

Lymphedema is swelling that happens when a fluid called lymph (or lymphatic fluid) can’t flow normally and builds up in the soft tissues of a limb. Lymphedema usually happens in parts of the body where lymph nodes have been removed or damaged by cancer treatment.

You may have lymphedema in your legs if lymph nodes were removed from your pelvis or groin. Lymphedema is more likely to occur if you were also given radiation therapy to the pelvis.

If you develop lymphedema, your healthcare team can suggest ways to reduce swelling as much as possible and help prevent more fluid from building up. This may include elevating the limb, exercising, wearing compression stockings and having physiotherapy. You can also ask for a referral to a healthcare professional who specializes in managing lymphedema.

Find out more about lymphedema.

Some types of treatments for penile cancer can cause changes to how you urinate (pee).

If you have your penis completely removed, the surgeon will create an opening between the anus and scrotum (called a perineal urethrostomy) so you can urinate while sitting down. You can still control urination because the muscle that keeps the bladder closed is further inside the body and isn’t affected by the surgery.

Radiation therapy directed to the tip of the penis may narrow the opening of the urethra. This can make it difficult to urinate normally, but it can be managed by stretching (dilating) the opening.

Talk to your healthcare team if you have these urination changes. They can help you manage them.

You may be worried about whether you’ll be able to get someone pregnant after cancer treatment.

Chemotherapy and radiation therapy can lower the number of healthy sperm made by the testicles. But this is usually temporary. Sperm production can return to normal after treatment is done. Sometimes it can take up to 2 years after treatment for sperm counts and health to return to normal.

If penile cancer has spread to the testicles, an orchiectomy may be done to remove the testicles. If both testicles are removed, you can no longer make sperm so you can’t get someone pregnant.

If you are concerned about preserving your fertility, talk to your healthcare team before starting treatment. You may be offered sperm storing or banking before treatments.

Find out more about fertility problems and how they can be managed.

To make the decisions that are right for you, ask your healthcare team questions about supportive care.