Radiotherapy for bladder cancer

Although you may have heard about radiotherapy from friends, relatives and/or other patients, it is important to remember that their experience may not be the same as yours. In all cases, a doctor will explain your radiotherapy treatment to you and answer any questions you may have.

We are here to help, so if you would like further information or have any particular concerns, please do not hesitate to ask your radiographer or a member of the radiotherapy review specialist team.

In most cases, a friend, relative or carer may accompany you to your appointments. This will depend on any infection control guidelines currently in place. Please ask your doctor or a member of the radiotherapy team if this is possible.

What is radiotherapy?

Radiotherapy uses precise, carefully measured doses of high energy x-rays to treat cancer. Cancer cells are more sensitive to radiation than normal cells, so the aim of treatment is for the xrays to either destroy the cancer cells or stop them from growing, whilst avoiding and protecting the normal cells as much as possible.

Radiation also damages normal cells in or around the area being treated which causes side effects, but these will usually recover and heal after treatment.

Why use external beam radiotherapy to treat bladder cancer?

Radiotherapy may be given to treat and attempt to cure bladder cancer (radical radiotherapy) as an alternative to surgery, for example, when surgery to remove the bladder is not possible for medical reasons. Surgery may be reconsidered at a later date if the cancer returns, so you will be monitored after your radiotherapy treatment course finishes.

You will need to attend the radiotherapy department as an outpatient, for a course of daily treatments (Monday to Friday), over a period of four to six weeks.

Radiotherapy may also be used to relieve symptoms from bladder cancer, when the cancer has spread outside the bladder to other parts of the body (palliative radiotherapy). This would be a shorter course of treatment, with the aim of controlling symptoms and minimising side effects.

Chemotherapy

Some patients may receive a course of chemotherapy (where medicine is used to kill the cancer cells) prior to radiotherapy, known as induction chemotherapy. Chemotherapy may also be given during radiotherapy (chemo-radiation) to try to make cancer cells more sensitive to radiation. Both are administered as an outpatient treatment.

Chemotherapy may increase the risk of side effects, particularly infection and bleeding, and so will not be recommended for all patients. The chemotherapy team will give you specific information leaflets on chemotherapy if it is recommended.

If you require chemotherapy with your radiotherapy, you will need weekly blood tests while you are on treatment, which we will usually aim to do on a Friday morning.

Your radiotherapy planning appointment

Prior to your radiotherapy treatment starting, you will need to attend the radiotherapy department for a CT planning scan. Before the scan, you will be asked to ensure your bowels and bladder are both empty.

Having an empty bladder means that we can minimise the area to be treated and therefore the side effects. If needed, you may need a catheter (a flexible tube used to empty the bladder) inserted before the planning scan, or a doctor may suggest one during the course of treatment. This does not affect the radiotherapy treatment.

Having empty bowels means that the position of your bladder will not be moved by the bowels being a different size each day, meaning we can make the treatment as accurate as possible.

 Your radiotherapy treatment appointments

The actual radiotherapy treatment is similar to having an x-ray or scan. You will need to follow your specific bowel and bladder preparation schedule prior to each appointment. Each session takes approximately 15 minutes in total, most of which is spent ensuring you are in the correct position, although the actual delivery of the radiation lasts only a few minutes.

Sometimes it can take longer if your internal organs are not in the correct position. On rare occasions we may not be able to proceed with your treatment if we cannot be confident that it is going to be as accurate as needed.

Short term side effects of radiotherapy treatment

Some side effects are short term, usually peaking about two to three weeks after you finish your treatment and then taking a further two to three weeks to improve. However this will not be the case for all patients. Possible short term side effects from radiotherapy for bladder cancer are:

Bladder irritation

Radiotherapy may cause the bladder to become irritated. This may make you to want to pass urine more frequently and experience a burning sensation while doing so. Please aim to drink plenty of fluids (two litres/three pints, per day) but avoid acidic drinks (e.g. fruit juices and sugary drinks), alcohol, fizzy drinks or drinks with caffeine (e.g. tea, coffee) that can make the symptoms worse. Drinking more through the day and less in the evening may help you to pass less urine at night.

Bowel irritation

The bowel may become irritated, and you may experience some diarrhoea. Please let us know if this happens, so we can help you manage this effectively. This may include adjusting your radiotherapy preparation or using some medications.

Loss of pubic hair

You may lose some pubic hair. This often grows back, but may be thinner and/or a different texture than before.

Discolouration of skin

Your skin may become discoloured in the treated area. We advise you not to soak in hot baths, to use a mild, non-perfumed soap and to pat the area dry rather than rubbing. Please do not use talcum powder or any lotions and creams other than those advised by us.

Tiredness

You may become tired. Gentle exercise may help but save your energy for activities you enjoy doing. You may experience some or all of these side effects. Please always let the radiotherapy team know of anything worrying you, as we want to help you recover as soon as possible.

Long term side effects of radiotherapy treatment

Some side effects are long term. These usually occur around three months after finishing your course of treatment but can sometimes start much later.

Bladder and bowel function

There is a potential risk of permanent damage to the bladder and bowel, for example:

• The bladder may not hold as much urine as before, so you may need to pass urine more frequently.
• Bowel movements may become more loose or frequent than before. Rarely, you may experience diarrhoea.
• Blood vessels in the bladder or bowel may become more fragile and you may notice blood in your urine, or poo.

Please let your doctor know if you experience any of these side effects as you may require additional tests. There may also be treatments that can help.

Fertility and sexual function

Common side effects are listed below, but please discuss your individual circumstances with your doctor or radiotherapy review specialist:

• Women might find their vagina becomes dry and tight, but we can advise you about ways to minimise this. Women are also at risk of early menopause. Please talk to your doctor if this is a concern for you.
• Men may lose their ability to have an erection. There are different treatments available, which may help.
• Radiotherapy to the bladder is likely to make you infertile (not be able to have children). We do not recommend that you try to have children during your radiotherapy. You should use barrier contraception during treatment and for three months afterwards. Your doctor will discuss this with you before you start treatment.

After your treatment

You may be referred back to your surgeon for follow up care or your radiotherapy doctor, depending on the treatment you have received.

Usually, you should expect an out-patient appointment to be arranged for four to six weeks after completing your treatment. This may sometimes be a telephone appointment. Outpatient appointments will then continue initially on a three to six monthly basis, or more frequently if required.