Bladder Cancer: Radiation Therapy
What is radiation therapy?
Radiation therapy is a treatment for cancer than uses rays of energy. A machine directs the rays of energy to the cancer. The energy rays kill cancer cells.
To get this treatment, you’ll see a radiation oncologist. This doctor sets your treatment plan. The plan tells what kind of radiation you’ll have 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 might radiation therapy be used to treat bladder cancer?
Radiation is often used as part of a treatment or as the only treatment for people with invasive bladder cancer. Here are the more common ways it’s used:
Radiation can be combined with minor surgery (such as a transurethral resection of the cancer) that doesn't involve removing your entire bladder. In some cases, chemotherapy is given with the radiation. This is called chemoradiation.
Radiation can be used after a surgery (radical cystectomy). This is done to help destroy any cancer cells that are left in your body.
Radiation sometimes is used as the main treatment instead of any surgery. This may be especially likely in people who aren’t healthy enough to have surgery.
Radiation can be used to ease symptoms from cancer that’s grown or spread.
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 to 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 for 5 days in a row. 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 your 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 directed. This process is called a simulation.
What happens during simulation
This visit may take up to 2 hours. During the simulation process, you’ll lie still on a table while your healthcare provider uses a machine to define your treatment fields. He or she will likely use a CT scan or an X-ray machine. These 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 colored 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 help keep you from moving during the treatment.
What happens during daily radiation treatments
On the days you have radiation, you may have to change into a hospital gown. Your healthcare provider may ask you to have a full bladder or an empty bladder before treatments. You’ll lie on a table while the machine is placed over you. It’s like getting an X-ray, only it lasts longer. The whole process takes about 15 to 30 minutes. The therapist lines up the machine exactly with your marked treatment fields.
The therapist will leave the room to turn on the machine, but you’ll be able to talk to him or her over an intercom. Sometimes X-ray images or a "cone beam CT scan" are taken for alignment before each treatment. Then the therapist will give the treatment. The cone beam CT scan has the machine rotate around you taking X-rays. After you’re aligned, the therapist will give the radiation. You can’t feel radiation, and the machine will not touch you. You may hear whirring or clicking noises. You won’t be radioactive afterwards.
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 much less than the benefit of killing cancer cells. Some people have no side effects at all. Side effects are related to the dose of radiation you get and the area of your cancer. In general, you’ll only have side effects in the area that’s been treated.
Common side effects from radiation treatment include the following:
Extreme tiredness or fatigue
Irritation, blistering, and peeling at the site on your skin where you received the radiation
Bladder irritation. This can cause 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. They 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 how to control them. Most of these side effects go away a few weeks after you stop getting treatment.
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.
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.
March 21, 2017
Herold, David M., MD,Stump-Sutliff, Kim, RN, MSN, AOCNS