Radiotherapy
What is radiotherapy
Radiotherapy is the use of exact, carefully measured doses of radiation to treat disease (mainly cancer).
It works by directing x-rays at the tumour (cancer) in order to destroy any abnormal cells that may be there. These abnormal cells are more sensitive to radiotherapy than normal cells and will be destroyed. Normal cells within or close to the treated area will also be affected and this can cause side effects but the cells are usually able to repair. The radiotherapy is given to try and kill the cancer cells and reduce the risk of the cancer returning.
Radiotherapy for bladder cancer is given from outside of the body (external beam radiotherapy). The number of radiotherapy treatments received and how frequently will depend on the extent, size and type of the tumour. Radiotherapy treatment is painless and will not make you radioactive.
It is very important that female patients tell their oncologist immediately if they suspect they may be pregnant.
Radiotherapy can be used for a number of different reasons in bladder cancer.
- Potentially curative radiotherapy (radical radiotherapy) This is usually given over a four to six and a half week period, with treatment given usually as an outpatient for five days a week (Monday to Friday). The treatment is painless and takes about 20 minutes
- Non curative (palliative) radiotherapy This may be given to help control symptoms such as bleeding in the urine or to slow the growth of the bladder cancer but is not likely to cure patients.
There are a number of different people involved in radiotherapy treatment. Radiographers are the team members who deliver the treatment on a daily basis.
Planning radiotherapy
The radiotherapy treatment has to be carefully planned so that you will receive the maximum benefit from the treatment.
The first visit to the radiotherapy department will be to design the treatment which is likely to involve a special type of CT scan called a planning scan. This can only be done in a radiotherapy department and is additional to any other scan you may already have had.
Before the treatment is planned, you will be asked to sign a consent form if you have not already done so. Immediately before this scan, you may be asked to empty your bladder fully. It may be necessary for you to remove some clothing to allow the radiographers to see the treatment area but they will try to keep you as covered as possible. The scan is painless and this appointment takes about 20 minutes.
During the procedure, the radiographers may draw some marks onto your skin and may ask your permission to make some of these marks permanent with a small needle. These tiny permanent marks, together with measurements taken at this planning appointment, will ensure the pinpoint accuracy of your treatment on a day-to-day basis.
Some patients do not have a planning scan but attend the simulator in radiotherapy for their planning. This means that other types of x-rays are taken at this appointment rather than a CT scan, to help design the treatment.
It is important you lie as still as you can throughout the procedure.
After the planning appointment, you will be given a list of dates and time for your treatment. Treatment usually starts as soon as possible but some treatments require detailed planning and take several days to prepare.
There is no medical reason why patients cannot drive during radiotherapy and there is no risk to family members from close contact during radiotherapy.
Sometimes chemotherapy will be given during the radiotherapy treatment itself to make the radiotherapy work better. This is called chemoradiation. This is usually given as an outpatient appointment however you will require regular blood checks every week. You may have more side effects than if you are having radiotherapy without additional chemotherapy particularly the risk of getting infections and bleeding.
Side effects of radiotherapy: early reactions
Fatigue
As radiotherapy can damage normal tissues close to or in the treated area, tiredness is very common, as your body will use a great deal of energy to repair these damaged cells. If you feel fit enough, gentle exercise can help. Do not force yourself to do things you do not have the energy to do.
Sore or red skin (erythema)
Radiotherapy can make the skin in the treated area become itchy, red and sore. You can minimise this by the following:
- Wear loose fitting clothing made of natural fibres such as cotton
- Wherever possible allow air flow to the area
- Protect the affected area from the extremes of heat or cold
- Avoid activities such as swimming where the chemicals may irritate your skin
- Do not allow the affected area to be exposed to the sun
- Bathing and showering is allowed, but when washing the treatment area use water which is not too hot or too cold
- Avoid wet shaving in the treatment area.
- Wash only with “simple” or baby soap and do not use shower gels, bath products or deodorants in the treatment area.
- Gently pat the skin dry with a soft towel after bathing. Do not rub the skin
- You may find that applying aqueous cream or E45 cream onto the treatment area twice a day will help. The cream can be stored in the fridge to soothe warm inflamed skin
- Do not use any creams on pelvic skin reactions without first checking with a member of your treatment team.
After radiotherapy the skin will take some time to recover after treatment finishes. Reactions may get worse before improving in the first two weeks after radiotherapy. If you have any questions regarding skin care you can contact your specialist nurse or the radiotherapy department for advice.
Skin in the treatment area will be more sensitive to sun exposure in the future and it is important to use a high factor sun block to protect your skin.
Bladder symptoms
You may experience changes in the flow of your urine, a need to pass urine more often, a need to pass urine urgently, a burning sensation on passing urine and /or a small amount of blood in your urine.
Your consultant may be able to prescribe you something to help with these symptoms. Drink plenty of water based fluids such as cordial. Tea and coffee can make the symptoms worse. Some people find cranberry juice helpful. Please tell the radiographers about any of these symptoms so that they can ensure you do not have an infection. Always report any difficulty in passing urine to the staff.
In the long term (months or years after radiotherapy), 1 in 5 patients will notice some minor changes with their bladder function. It is rare for this to make life more difficult for you but that can happen for a minority of patients. The bladder usually works well after radiotherapy although some patients find it holds less urine and they may need to urinate more frequently or have some urgency. A minority of patients will need an operation because of damage to the bladder caused by radiotherapy however this is very rare. Radiotherapy can also cause some bleeding in either the urine or bowels in the long term and this should always be mentioned to your consultant.
Bowel symptoms
Treatment may irritate your bowel and you might need to go to the toilet more often. Medication such as Fybogel may be prescribed for you. You may develop tenesmus, which is an urge to open your bowels without passing anything. This can feel like constipation. You may notice an increase in the amount of wind you pass. If opening your bowels becomes painful or you notice some spotting of blood tell the radiographers. These side effects are common. Please do not modify your diet without discussing it with a consultant or radiographer.
In the long term, 1 in 5 patients may notice some minor changes with their bowels with increased urgency or frequency. Medication can usually be given to help with this. It is very rare to need an operation to correct damage caused to the bowel by radiotherapy.
Vaginal changes
Radiotherapy to the lower abdomen in women is likely to induce the menopause. A reaction called vaginal stenosis may occur as a result of scar tissue forming after radiotherapy. Vaginal dilators can be given to those having radiotherapy to try to prevent this from happening.
Lack of semen or reduced sperm count in males may result in infertility.
