Bladder Cancer: Radiation Therapy
What is radiation therapy?
Radiation therapy is a treatment for cancer that uses rays of energy to kill cancer cells. A machine directs the rays of energy to the cancer.
To get this treatment, you’ll see a radiation oncologist. This doctor makes your treatment plan. The plan tells what kind of radiation you’ll have, the dose, and how long the treatment will last. Your doctor can tell you what to expect during treatment. He or she can also tell you how you may feel during and after the treatment.
When is radiation therapy be used for bladder cancer?
Radiation can be used as part of treatment or, less often, as the only treatment for people with invasive bladder cancer. It's most often used to treat higher stage (3 and 4) cancers that haven't spread to other parts of the body. Here are the more common ways it’s used:
Radiation can be given after surgery that doesn't involve removing your entire bladder. It's used to kill any cancer cells that may be left behind. In some cases, chemotherapy is given with the radiation. This is called chemoradiation.
- Radiation may be used before surgery to help shrink a tumor so that less of the bladder needs to be removed.
Radiation can be used after surgery was done to remove the bladder (radical cystectomy). The radiation can help kill any cancer cells that might be left in the area.
Radiation sometimes is used as the main treatment instead of any surgery. This is more likely in people who aren’t healthy enough to have surgery. If possible, chemo is given at the same time.
Radiation can be used to ease symptoms from cancer that’s grown or has spread to only 1 or 2 places.
How is radiation given?
Your radiation oncologist chooses your treatment plan. A radiation therapist gives you the radiation.
Radiation to treat bladder cancer is called external radiation. The radiation comes from a machine. It’s directed at the tumor from outside of your body. You can’t feel the radiation. It's a lot like getting an X-ray. External radiation is normally given on an outpatient basis in a hospital or a clinic. You’ll likely get treatments once a day, 5 days a week. You’ll do this for about 3 to 8 weeks. Each session takes only a few minutes. You don’t need to stay overnight in a hospital.
If you have questions about external radiation, ask your healthcare provider before agreeing to treatment. All of your concerns should be addressed before treatment starts.
Before your first radiation session, you’ll have an appointment to learn where on your body the radiation beam needs to be focused. This process is called a simulation.
What happens during simulation
This visit may take up to 2 hours. During simulation, you’ll lie still on a table while the treatment team defines your treatment fields. A CT scan or an X-ray machine will most likely be used to see exactly where the tumor is. These treatment fields are also called treatment ports. This is the exact spot on your body where the radiation will be aimed. Your skin may be marked with tiny dots of permanent ink or tattoos. This is done so the radiation can be aimed at the exact same place each time.
You may also have body molds made to hold you in the exact same position and help keep you from moving during the treatments.
What happens during daily radiation treatments
On the days you have radiation, you may have to change into a hospital gown. You'll be told if you need to have a full or empty bladder before treatment. You’ll lie on a table while the machine moves over you. The whole process takes about 15 to 30 minutes. The therapist gets you into position and lines up lights from the machine with treatment fields marked on your skin.
The therapist will leave the room to run the machine, but you’ll be able to talk to and hear him or her the whole time. Sometimes X-ray images or CT scans are taken to check alignment before each treatment. After you’re aligned, the therapist will give the radiation. You can’t feel radiation. The machine may move, but it won't touch you. You may hear whirring or clicking noises. You won’t be radioactive afterward.
What are common side effects of radiation therapy?
Because radiation affects normal cells as well as cancer cells, you may have some side effects. Usually, the risk of side effects is less than the benefit of killing cancer cells. Side effects depend on the dose of radiation you get and the area treated. In general, side effects only affect the part of your body that’s treated.
Common side effects from radiation treatment include:
Extreme tiredness (fatigue)
Irritation, blistering, and peeling of the skin where the radiation goes in, and maybe out of, your body
Bladder irritation. This, leads to more frequent urination and burning with urination. You may see blood in your urine or the color of your urine may change. Call your healthcare provider if you think you’re bleeding. In some cases, it can be serious. This can become a long-term problem.
Diarrhea, bloating, gas, and bowel irritation
Leaking urine or an urgent need to urinate. This can become a long-term problem.
Loss of the ability to get or keep an erection (impotence)
Vaginal irritation, burning, discharge, and dryness
Nausea or vomiting
Loss of control of your bowel movements (bowel incontinence)
Mucous discharge with bowel movements
Ovary damage. This can cause menopause and infertility in young women. You may need hormone replacement.
The side effects of radiation treatment can be unpleasant, but they usually aren’t dangerous. Talk with your healthcare team about side effects you might have and how to control or treat them. Most side effects go away over a few weeks after treatment ends.
Working with your healthcare provider
To help deal with the medical information and remember all of your questions, bring a family member or close friend with you to your appointments. It may also help to bring a written list of concerns. This will make it easier for you to remember your questions about radiation. You can also take notes on what the doctor says.
Talk with your healthcare team about what side effects to look for and when to call them. 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. Write down physical, thinking, and emotional changes. 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.
October 05, 2018
Richard LoCicero MD,Kim Stump-Sutliff RN MSN AOCNS,Lu Cunningham