Radiotherapy for invasive and advanced bladder cancer
Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells while doing as little harm as possible to normal cells. Radiotherapy may be given to try to cure bladder cancer (radical radiotherapy) or to relieve symptoms (palliative radiotherapy).
Radiotherapy for bladder cancer is given using equipment similar to a large x-ray machine and is called external radiotherapy.
Radiotherapy to cure the cancer (radical radiotherapy)
Back to top
If you have stage 2 or stage 3 bladder cancer, you may be offered radiotherapy with the aim of curing the cancer. Having radiotherapy instead of a cystectomy means you’ll still have your bladder. However, if the cancer comes back later on you may still need to have your bladder removed. You’ll need to have cystoscopies about every three months or so after your radiotherapy to check that the cancer has not come back.
How it is given
Radiotherapy is given in the hospital radiotherapy department as a series of short daily treatments. You can usually have it as an outpatient. Each treatment takes 10-15 minutes, and they are usually given Monday-Friday, with a rest at the weekend.
A course of radiotherapy for bladder cancer may last 4-7 weeks. Your doctor will discuss the treatment and possible side effects with you.
External radiotherapy does not make you radioactive and it is perfectly safe for you to be with other people, including children, after your treatment.
You may have chemotherapy before your radiotherapy treatment. Some people have chemotherapy at the same time as radiotherapy to help make radiotherapy more effective. This is called chemoradiation.
Radiotherapy has to be carefully planned to make sure it’s as effective as possible. It is planned by a cancer specialist (clinical oncologist), and it may take a few visits. On your first visit to the radiotherapy department, you’ll be asked to have a CT scan or lie under a machine called a simulator, which takes x-rays of the area to be treated. Marks are usually drawn on your skin to help the radiographer (who gives you your treatment) position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and about three permanent marks (like tiny tattoos) may be used. These are extremely small and will only be done with your permission. It may be a little uncomfortable while they are done.
At the beginning of each session of radiotherapy, the radiographer will position you carefully on the couch and make sure you’re comfortable. During your treatment you’ll be alone in the room, but you can talk to the radiographer, who will watch you from the next room. Radiotherapy is not painful, but you have to lie still for a few minutes during the treatment.
After your radiotherapy treatment you’ll have regular cystoscopies to check the inner lining of the bladder for any sign of the cancer coming back.
Bladder and bowel symptoms
Radiotherapy to the bladder area may irritate the bowel and cause diarrhoea and soreness around the anus (opening of the bowel to the outside). Eating a low-fibre diet may help reduce diarrhoea. This means avoiding wholemeal bread and pasta, raw fruit, cereals and vegetables during and for a couple of weeks after treatment.
Radiotherapy can also cause inflammation of the bladder (cystitis), which makes you want to pass urine more often and causes a burning feeling when you pass urine.
Your doctor can prescribe medicines to reduce these symptoms. Drinking plenty of fluids (2 litres/3 pints a day) will also help. These effects usually disappear gradually a few weeks after the treatment has ended.
Effects on the skin
These are generally mild, but perfumed soaps, creams or deodorants may irritate the skin and should not be used during treatment. You’ll be given advice on how to look after the skin in the area being treated.
Radiotherapy can cause tiredness. In some people this continues for several months after treatment.
During your treatment, you’ll need to rest more than usual, especially if you have to travel a long way for treatment each day. But it’s good to do gentle exercise, such as walking, when you feel able.
Once your treatment is over, gradually increase your activity and try to balance rest periods with exercise, such as walking. This will help build up your energy levels.
Loss of hair in genital area (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, but may be thinner than it was.
Possible long-term side effects
Back to top
Effects on the vagina
In women, radiotherapy to the pelvis can narrow the vagina, which can make sex difficult or uncomfortable. This can be avoided by keeping the tissue in the vagina as supple as possible.
One of the best ways of overcoming this problem is to start having sex regularly as soon as you feel ready. Alternatively you can use vaginal dilators. Your nurse or doctor can show you these and explain how to use them. Hormone creams applied to the vagina can also help. These can be prescribed by your doctor.
Effects on ability to have erections
For men, radiotherapy to the pelvis can make it more difficult to have an erection. There are different treatments that can help.
We have more information on sexuality and cancer, and the late effects of pelvic radiotherapy in women and men.
Radiotherapy to the pelvic area is likely to cause infertility in men and women. If you have concerns about your fertility, it’s important to talk to your doctor before your treatment starts.
Effects on the bowel or bladder
In some people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens, symptoms generally develop six months to two years after radiotherapy treatment, although in some people it may be years later.
If your bowel is affected, you may have bowel motions more often and have diarrhoea. Sometimes the bladder shrinks after radiotherapy and can hold less, so you need to pass urine more often.
The blood vessels in the bowel and bladder can become more fragile, and if this happens, blood appears in the urine or in bowel movements. If you notice any blood in your urine or bowel movements, it’s important to let your doctor know so that tests can be done and the appropriate treatment given.
We have more information on the long-term side effects of pelvic radiotherapy for men and women.
Radiotherapy for symptom control
Back to top
If the cancer has spread outside your bladder to other parts of your body, you may be given radiotherapy to treat the symptoms. This is known as palliative radiotherapy. This can usually be given in about 1-5 sessions. Side effects are uncommon and generally mild if they do occur.
Treating bladder symptoms
If you’re having symptoms in your bladder, such as pain or bleeding, radiotherapy may be used to relieve them. This treatment is often given as three sessions over a week, usually on alternate days (on Monday, Wednesday and Friday, for example). Each treatment takes around 10-15 minutes. Sometimes this treatment may be given in one session.
Treating bone symptoms
Radiotherapy can also treat symptoms caused by cancer that has spread to the bones. Most often, just one radiotherapy treatment is needed to treat an affected bone. Sometimes up to five treatments are given over five days. It can take up to 4-6 weeks for the full benefits to be felt, but you may notice improvements in your pain much sooner than this.