Penile Cancer Treatment at Good Hope Hospital

Transcription

1 Penile Cancer Treatment at Good Hope Hospital Patient Information

2 Introduction This booklet is designed to give you information about penile cancer. We hope it will answer some of the questions that you or those who care for you may have at this time. It is not meant to replace the discussion between you and your surgeon but helps you understand more about what is discussed. Cancer of the penis is very rare, about 100 times less common than other cancers such as prostate and lung cancer. Every year in the UK there are about 350 new cases. An average local hospital will only see one to two cases every year. Because the disease is so rare, specialist centres that treat many more cases each year have been developed to improve the quality of treatment. Good Hope Hospital in Sutton Coldfield is one such centre, which sees about cases a year. Treatment of penile cancer is usually effective and the majority of men are cured completely, particularly if the disease is detected at an early stage. What causes penile cancer? As with many cancers we don t know the precise cause in most cases. We do know some facts: Penile cancer usually affects older men, most patients being over 60 years of age. However one in five will be under 40. It is rare in men who have had their foreskin removed in early childhood (circumcision). It is sometimes associated with previous exposure to genital warts (Human Papilloma Virus-HPV). However your partner is not at any increased risk of developing any form of cancer as a result of exposure to this. It is sometimes associated with a skin condition which affects the foreskin, called Balanitis Xerotica Obliterans (BXO). There is no genetic link that we are aware of, so we don t currently believe it could be passed on to your children or grandchildren. What are the symptoms and signs? The first signs are usually on the foreskin, or behind the foreskin on the head of the penis (glans). Typical signs are: 1

3 A red, velvety patch. A raw area which may have a smelly discharge (oozing or leaking fluid). A wart-like growth or ulcer. Bleeding or discharge from beneath the foreskin, particularly if the foreskin is tight and does not retract. All these may also be signs of less serious problems, but it is always wise to have symptoms like these checked out without delay. What happens if I am suspected of having penile cancer? Firstly you may need a biopsy to discover whether you do have penile cancer. This may be done either at your local hospital or at Good Hope Hospital. In some cases, particularly if the cancer is large, the diagnosis is very obvious and a biopsy is not needed. In other cases, if the cancer is small, it can be completely removed at the same time as the biopsy. In most cases, however, a biopsy is performed allowing treatment to be planned once the biopsy results are known. Having a biopsy A biopsy involves the removal of a small piece of tissue for examination under a microscope to enable a diagnosis to be made. Most biopsies are performed under general anaesthetic (when you are asleep), but sometimes they can be done under local anaesthetic (freezing the area while you are awake). If your foreskin is tight your doctors may recommend a circumcision is performed at the same time. Most men will leave hospital the same or following day, after a biopsy. What happens next? Biopsies normally take approximately one week to process. If cancer is confirmed, you will then be referred to Good Hope Hospital if you have not been seen there already. The biopsy material and any other relevant information will be sent to Good Hope and examined by the penile cancer team. You will receive an appointment to see Mr. Foster or a member of his team and your case will be discussed at the weekly team meeting so that your treatment can be planned. 2

4 What examinations and tests may I need? The team will ask you questions about your symptoms and about any past medical problems. They will need to examine your penis, testicles and groins. If you have swellings in your groins you may also require a biopsy or a fine needle aspiration of these swellings. A fine needle aspiration is where a small needle is inserted into the swelling and fluid is drawn off. You will probably have routine blood tests and depending on your type of cancer and your general state of health, you may have a CT scan. All men with penile cancers (except those with very small cancers) will have a CT scan at some stage, but this may be delayed until after the cancer has been treated. Will I need an operation? Most penile cancers are treated by surgery, so it is likely that you will need an operation of some sort. This will be fully discussed with you at your first clinic visit. Are there any alternatives to surgery? Small pre-cancerous growths (known as carcinoma-in-situ) can often be treated with drugs that are applied in the form of a cream to the abnormal area on the penis. This treatment is not suitable for all penile cancers, depending on their size and location. The drugs that are commonly used are called Imiquimod and 5- fluoruracil. These are chemotherapy drugs which can cause some local irritation and discomfort on the penis, but will not cause any general effects such as hair loss. The team will discuss these drugs with you if your cancer is suitable for this treatment. If you are very keen to avoid surgery, or are not fit enough for an operation, radiotherapy (X-ray treatment) can sometimes be used to kill the cancerous cells. This is an outpatient treatment on a daily basis. The number of days of treatment varies between different patients. In most cases, however, the results of radiotherapy are not as good as those of surgery, so it is not recommended as first choice treatment. What will happen if I do not have any treatment? If you do have cancer and no treatment is given it will continue to grow. It may also spread to other parts of your body and become fatal. All cancers are easier to treat if detected early. 3

5 What is involved with surgery? This depends on the size and position of your cancer and on your general state of health. The exact nature of any proposed operation will be discussed with you before your consultant and yourself make a joint decision to go ahead. The most usual operations are as follows: 1. Glansectomy (reconstructive surgery) For most men with penile cancer we can offer penile sparing surgery, sometimes known as a glansectomy because only the head of the penis (the glans) is removed. This involves removing the smallest possible amount of penile tissue necessary to get rid of the cancer and replacing this with a skin graft taken from your thigh. For these operations you will usually need to be in hospital for four to five days, although some patients can go home the day after their operation. You will have a catheter in your bladder (a tube which drains urine) which will allow the new tissue on the penis to heal. This needs to stay in place for a few days and if you go home the day after your surgery we will see you the following week in clinic to remove the catheter. The cosmetic result after this operation is never perfect, but the penis will look as close as possible to its appearance before you developed cancer. After reconstructive surgery you will be able to pass urine normally, and should still be able to get erections. If you undergo reconstructive surgery you will be given a separate information sheet with more details of what is involved. Detailed information outlining the risks and benefits of this procedure will be offered to you if this surgery is recommended for you. 2. Partial penectomy Occasionally reconstructive surgery is not appropriate, so the cancer and part of the penis is removed. This makes the penis look different and leaves it shorter. It is unlikely that after this operation you will be able to get an erection. You should, however, still be able to pass urine normally. Detailed information outlining the risks and benefits of this procedure will be offered to you if this surgery is recommended for you. 4

6 3. Radical or total penectomy Very rarely, if the cancer is very large, the penis has to be totally removed. During the operation the water pipe (urethra) is diverted to come out behind the scrotum. You will be able to control when you want to pass urine afterwards, but you will need to do this by sitting down on the toilet. Reconstructive surgery is available following a total penectomy. It is also possible to restore sexual function. If necessary sperm banking will be offered to you prior to treatment. This will be discussed with you by a member of the urology team. Further information outlining the risks and benefits of this procedure will be offered to you if this surgery is recommended for you. What are the risks of surgery? After any operation there is a risk of infection and some swelling an bleeding. After penile surgery there are added risks of urinary problems and erection problems, both of which can usually be treated. It is unlikely that your penis will look the same as it did before your operation, unless the tumour is very small. Men who have part of the penis removed sometimes have psychological problems adjusting to the surgery, for which we can offer assistance. The inguinal lymph nodes Lymph nodes are situated around the body and become enlarged when you develop an infection or a cancer in the area they serve. You may have noticed enlarged painful lymph nodes (swelling) in your neck when you have previously had a sore throat. The most common place for penile cancer to spread to is the inguinal lymph nodes, which are situated in the groin (at the top of the thigh). Knowing whether the inguinal lymph nodes are affected by the cancer can be very helpful in choosing the best treatment for you. It is sometimes very difficult to tell whether the inguinal lymph nodes are affected by the cancer. Examining them is not always easy, and infection can also cause them to swell. CT scans may help, but are not always reliable. For some men it is recommended that they have an operation to remove the inguinal nodes even if it is not possible to prove that they contain cancer. For men with certain types of penile cancer it has been shown that the chances of a complete cure are higher if they have this operation performed. 5

7 The operation has quite a high risk of complications so it is not always a straightforward decision. Your doctors will discuss with you whether or not you should have an operation on your lymph nodes. What is involved inguinal lymph node surgery? If you undergo inguinal lymph node surgery (usually called node dissection ) you will be given a separate information sheet with more details of what is involved. The lymph glands are removed through an incision in the groin at the very top of the thigh on each side. After the operation you normally stay in hospital for about five days. You will have a drain (plastic tube) in the wounds to remove excess fluid and, occasionally, you may go home with the drain in place. There is a risk of wound infection, and of swelling of the legs, scrotum and penis. Sometimes this swelling can go on for many weeks and very occasionally it can go on indefinitely. Other treatment If there is evidence that the cancer has spread to other areas of the body you may be offered chemotherapy. This is the use of special drugs that attempt to kill off the cancer cells wherever they are in the body. Some men may require further surgery but if this is necessary this will be discussed with you in detail. Such cases are rare. What follow up care will I require? After your operation you will be seen in clinic at Good Hope Hospital to discuss your results. At this first appointment (normally within two weeks) your wound will be examined and any further treatment plans will be discussed with you. Further scans will be arranged if this is necessary. Your ongoing follow up will be arranged at either Good Hope Hospital or your local Hospital. The role of your Clinical Nurse Specialist The Macmillan Clinical Nurse Specialist (CNS) is an experienced oncology nurse who works with the other members of the team to provide high quality medical and psychological care for men with penile cancer and their families. The CNS is there to clarify any information and discuss matters important to you. It is very important that you are able to have your 6

8 questions answered and concerns discussed and the CNS will make every effort to ensure this. You will be given a contact telephone number for the CNS so that you are able to contact him or her, should you have any worries or need further information when at home. The CNS will be on hand to co-ordinate any treatment and investigations throughout your treatment and follow up care. His or her responsibilities include: providing informational support, referring you to counselling if you need and ward visits during in-patient stays. Good Hope Hospital Good Hope Hospital is part of Heart of England NHS Foundation Trust. It is located less than one mile to the east of Sutton Coldfield town centre, and seven miles to the north-east of Birmingham city centre. It is accessible from junction 9 of the M42, junction 6 of the M6, or junction 5 of the M6 (exit for north-bound traffic only). It is also close to junctions 3 and 4 of the M6 toll road. The A38, A453 and A5127 pass close to the hospital. The hospital is located half a mile from Sutton Coldfield train and bus stations. For further directions see the hospital website Any questions? If you have any worries or questions, please contact your Clinical Nurse Specialist. It is important that you make a list of all medicines you are taking and bring it with you to all your follow-up clinic appointments. If you have any questions at all, please ask your surgeon, oncologist or nurse. It may help to write down questions as you think of them so that you have them ready. It may also help to bring someone with you when you attend your outpatients appointments. 7

9 Glossary of medical terms used in this booklet: Balanitis Xerotica Obliterans (BXO): a condition causing scarring and thickening (sclerosis) of the skin of the penis. Biopsy: a procedure in which a small piece of tissue is removed and examined under a microscope. Carcinoma in situ: an early form of carcinoma that has not attached to surrounding tissues. Catheter: a flexible tube that is passed through the urethra, into the bladder to drain urine. CT scan: Computerised Tomography (CT) uses special X-ray equipment to obtain many images from different angles. Then a specially designed computer programme joins them together to show detailed pictures of the inside of the body. Fine needle aspiration: a technique using a thin needle that is inserted into a mass or lump to extract cells that will be examined under a microscope. Human Papilloma Virus (HPV): a virus that can cause cancer. Lymph nodes: hundreds of small oval bodies that contain lymph. These act as a first line of defence against infections. Local anaesthetic: a local anaesthetic is a medicine that causes a complete loss of feeling to a specific part of your body without causing you to lose consciousness. Radiotherapy: X-ray treatment that uses high energy rays to damage or kill cancer cells. Where to find more information You might also find it useful to look at the following information: The Cancerhelp UK website: Macmillan Cancer Support website: 8

10 For details of local cancer support groups and organisations, please ask your CNS or visit Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone:

11 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: June 2010 Review Date: June