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Penile cancer

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Supportive care for penile cancer

Supportive careSupportive careTreatment given to improve the quality of life of people who have a serious illness (such as cancer). helps men meet the physical, practical, emotional and spiritual challenges of penile cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of men living with cancer and their loved ones, especially after treatment has ended.

 

Recovering from penile cancer and adjusting to life after treatment is different for each man, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A man who has been treated for penile cancer may have the following concerns.

Self-esteem and body image

How a man feels about or sees himself is called self-esteem. Body image is a man’s perception of his own body. Penile cancer and its treatments can affect a man’s self-esteem and body image. Often this is because cancer or cancer treatments may result in body changes, such as:

  • loss of all or part of the penis
  • loss of the ability to urinate standing up
  • loss of the ability to have an erection
    • This is more likely to happen following external radiation therapy rather than brachytherapy for penile cancer.
    • Erections may be preserved if a man has penile-sparing surgery.
  • feeling embarrassed about the appearance of a reconstructed penis
    • Some men may have a bone graft implanted in the reconstructed penis to allow penetration during intercourse.
    • Other men may choose to have a semi-rigid implant.
    • With both bone graft implants and semi-rigid implants, the penis is erect at all times.

Some of these changes can be temporary, others will last for a long time and some will be permanent.

For many men, body image and their perception of how others see them is closely linked to self-esteem. It may be a real concern for them and can cause considerable distress. They may be afraid to go out, afraid others will reject them and feel angry or upset. Even though the effects of treatment may not show on the outside, body changes can still be troubling because the “old body” is lost and because of the importance of the particular change in the body to the person.

Sexuality

Many men continue to have strong, supportive relationships and a satisfying sex life after penile cancer. Sexual problems that can occur because of penile cancer treatment include:

  • the inability to have intercourse with penetration (if the penis was removed)
    • Some men may be able to have reconstructive surgery to allow intercourse with penetration.
    • Men can also ejaculate into the perineal urethrostomy (the opening made between the anus and scrotum that they urinate through).
    • Men may find other ways to enjoy sex without having intercourse with penetration.
  • erectile dysfunction (ED)
    • ED is the inability to get and keep an erection firm enough to have sex.
  • decreased libido (loss of sex drive)
    • If the testicles are removed, testosterone levels will be lower. This can lead to a loss of sex drive.
    • Some men who have surgery for penile cancer may lose interest in sex because they feel embarrassed about the change in appearance or loss of the penis.
  • infertility
    • Infertility is the inability to conceive a child.
    • This occurs if the testicles are removed.

It is common to have less interest in sex during diagnosis and treatment. When the man first starts having sex after treatment, he may be afraid that it will be painful or that he will not have an erection or orgasm. The first attempts at being intimate with a partner may be disappointing. Some men and their partners may need counselling to help them cope with these feelings and the effects of cancer treatments on their ability to have sex.

Lymphedema

Lymphedema is the swelling that occurs when lymph fluid builds up in the soft tissues. The lymph nodes work like small filters in the body. They filter extra body fluids, abnormal cells and cells that cause infections.

Lymphedema may occur in a man’s legs if he had lymph nodes removed from his groin or pelvis during penile cancer surgery. Lymphedema is more likely to occur if radiation therapy to the pelvis was also given.

Urinating

A partial penectomy leaves enough of the penis for normal urination. The man can often still stand up to urinate and direct the stream of urine away from his body. Many men who have had a total penectomy must sit to urinate. The surgeon makes an opening between the anus and scrotum (perineal urethrostomy) so that urine can be passed out of the body. The man can still control urination because the muscle that keeps the bladder closed is further inside the body, above the penis. The healthcare team will teach the man how to care for the perineal urethrostomy.

Radiation therapy directed at the tip of the penis can narrow the opening of the urethra in up to 20% of cases. Narrowing of the urethra can make it difficult to urinate normally, but it can be managed by stretching (dilating) the opening. Men are often taught how to do this themselves.

See a list of questions to ask your doctor about supportive care after treatment.

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