Chemotherapy, or chemo, uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells, which grow quickly. Some normal cells also grow quickly. Because of this, chemotherapy can also harm those cells. This can cause side effects.

Chemotherapy might be part of the treatment for penile cancer in different cases:

• If you have very early stage penile cancer, chemotherapy might be applied as a cream. This is called topical chemotherapy.

• If penile cancer is has grown too far to be removed by surgery or has spread to nearby lymph nodes, you may get chemotherapy. Sometimes you may have it along with radiation therapy. This is to try to shrink the cancer so it can be removed. This is known as neoadjuvant therapy.

• Chemotherapy is typically part of treatment if penile cancer has spread to other parts of the body.

Before treatment starts, you will meet with a medical oncologist. This is a doctor with special training to treat cancer with medicines such as chemotherapy. The doctor will discuss your treatment options with you and tell you what you might expect.

Chemotherapy for penile cancer can be given either systemically or as a topical treatment. 

• In systemic chemotherapy, you get chemo as an injection into your vein (IV) or as a pill to swallow. The medicines travel in your bloodstream, killing cancer cells all throughout your body. Systemic chemotherapy is able to reach cancer that may have spread deeply into your skin or to other parts of your body. 

• In topical chemotherapy, your doctor gives you a cream to put on the skin of your penis. It can kill cancer cells near the surface of your skin, but it can't reach cancer cells that are deep in your skin or that have spread to other organs. 

You usually get systemic chemotherapy as an outpatient. That means that you get it at a hospital, clinic, or healthcare provider's office. You can go home after the treatment is given. You'll be watched for reactions during your treatments. Each chemotherapy treatment may last for a while, so you may want to take along something that is comforting to you, such as music to listen to. You may also want to bring something to keep you busy, such as a book or mobile device.

To reduce the damage to healthy cells and to give them a chance to recover, chemotherapy is given in cycles. Each cycle consists of one or more days of treatment, followed by some time to rest. Cycles typically last 3 or 4 weeks. Your healthcare provider will discuss your chemotherapy schedule with you.

Some of the chemo drugs used to treat penile cancer include:

• Cisplatin

• Docetaxel

• Fluorouracil

• Ifosfamide

• Mitomycin C

• Paclitaxel

Often, two or more of these drugs are used together.

For topical chemotherapy, fluorouracil is available as a cream. 

Side effects of chemotherapy are different for each person. They vary based on the medicines you get. Below are some of the most common side effects from chemotherapy for penile cancer. Ask your doctor or chemotherapy nurse for details about the side effects for the medicines you are getting.

• Hair loss. If you have hair loss, the hair will usually grow back after the treatment stops.

• Nausea and vomiting. This side effect can be usually controlled with medicines. Ask your healthcare provider about it.

• Mouth sores. Chemo can sometimes cause mouth sores. These might make it hard for you to eat or swallow. It's important to keep your mouth very clean and avoid foods and substances that could irritate your mouth.

• Diarrhea. If you have diarrhea, take antidiarrheal medicines as prescribed by your healthcare provider. You may also need to make changes in your diet.

• Loss of appetite or changes in the way things taste. Talk with your healthcare provider if you find you are having trouble eating or are losing weight. He or she may have suggestions.

• Increased risk for infection. During your chemo treatments, your white blood cell count may become low. This means your immune system won’t be working as well as it usually does. It’s a good idea for you to avoid people who have illnesses that you could catch. It’s also a good idea to take extra precautions against cuts and scrapes that could become infected. Your healthcare provider will check your blood counts regularly during your treatment. Be sure to let your doctor or nurse know if you have any signs of possible infection. These include fever, sore throat, a new cough, or burning during urination.

• Bleeding and bruising more easily. Chemo can also lower your blood platelet counts. You need platelets to help the blood clot properly. 

• Fatigue. You may feel tired while getting chemotherapy. This usually goes away once treatment ends. 

Some other side effects can also be seen with certain chemo medicines. For example, cisplatin, docetaxel, and paclitaxel can cause nerve damage (neuropathy). This can lead to pain, tingling, and numbness in the hands and feet.

It's important to know which medicines you're taking. Write your medicines down, ask your healthcare team how they work, and what side effects they might have. Keep a written diary of your treatment schedule and any signs or symptoms you have.

Talk with your healthcare providers about what signs to look for, and when to call them.  For example, chemotherapy can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

 It may be helpful to keep a diary of your side effects. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.