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Friday, June 6, 2008

Radiotherapy for invasive bladder cancer

Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells.

When it is given

Radiotherapy for bladder cancer is often given as an alternative to surgery, which might then only be needed if the cancer comes back later on. Giving radiotherapy means that the bladder does not need to be removed, but you will need to have cystoscopies (usually every three months or so) after the treatment to make sure that the cancer has not come back.

The treatment is normally given in the radiotherapy department as a series of short daily sessions. The treatments are usually given from Monday to Friday, with a rest at the weekend. The number of treatments will depend on the type and size of the cancer, but the whole course of treatment will usually last from 4–7 weeks. Each treatment takes from 10–15 minutes. Your doctor will discuss the treatment and possible side effects with you.

Radiotherapy does not make you radioactive and it is completely safe for you to be with other people, including children, throughout your treatment.

Planning radiotherapy

Planning is a very important part of radiotherapy and makes sure that it is as effective as possible. It may take a few visits.

On your first visit to the radiotherapy department, you will have a CT scan or will be asked to lie under a machine called a simulator, which takes x-rays of the area to be treated. The treatment is planned by a clinical oncologist (a cancer specialist). A radiographer is the person who gives you your treatment.

Marks are usually drawn on your skin to help the radiographer to position you accurately and to show where the rays are to be directed. These marks must stay visible throughout your treatment, and permanent marks (like tiny tattoos) may be used. These marks are very small, and will only be done with your permission. The marks can sometimes be removed afterwards by laser. You can ask the staff at the radiotherapy department if they can arrange this.

Treatment sessions

At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch, and make sure you are comfortable. During your treatment you will be left alone in the room but you will be able to talk to the radiographer who will be watching you from the next room. Radiotherapy is not painful but you do have to lie still for a few minutes while the treatment is being given.


A radiographer watches on a monitor while treatment is given
A radiographer watches on a monitor while treatment is given

Side effects

Radiotherapy to the bladder area may irritate the bowel and cause diarrhoea and soreness around the anus. It may also cause mild cystitis, which can make you want to pass urine more often or cause a burning feeling when you pass urine. Your doctor can prescribe medicines to reduce this. These effects usually disappear gradually a few weeks after the treatment has ended.

Effects on the skin

Perfumed soaps, creams or deodorants may irritate the skin and should not be used during the treatment. At the beginning of your treatment you will be given advice on how to look after the skin in the area being treated.

Effects on the vagina

For women, radiotherapy to the pelvis can make the vagina become narrower and this can make sex difficult or uncomfortable. This can be avoided by keeping the muscles in the vagina as supple as possible. Hormone creams applied to the vagina, can help and these can be prescribed by your doctor. Regular sex, or use of a vaginal dilator, is often the easiest and most effective treatment. Our sections on sexuality and pelvic radiotherapy in women have detailed information about this.

Effects on ability to have erections

For men, radiotherapy to the pelvis can make it more difficult to have an erection. There are various treatments which can help. Our sections on sexuality and pelvic radiotherapy in men have detailed information about this.

Tiredness

Radiotherapy can also cause general side effects such as tiredness. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The radiotherapist will tell you what to expect.

It is important to try to get as much rest as you can, especially if you have to travel a long way for treatment each day.

Loss of pubic hair

During radiotherapy to the pelvis you may lose some of your pubic hair. When you have finished the course of treatment, the hair will often grow back. However, the re-growth may be thinner or finer than it was before.

After radiotherapy

After your radiotherapy treatment you will have regular cystoscopies to check the inner lining of the bladder for any recurrence of the cancer.

Possible long-term side effects

In a small number of people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or you may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can make blood appear in the urine or in bowel movements. This can take many months or years to happen. If you notice any blood in your urine or stools it is important to let your doctor know so that tests can be done and appropriate treatment given.

We have further information about treatments for the long-term side effects of pelvic radiotherapy.

Infertility

Radiotherapy to the pelvic area is very likely to cause infertility in both men and women.

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