Radical radiotherapy for bladder cancer

Radiotherapy uses high-energy rays called radiation to treat cancer. It destroys cancer cells in the area where the radiotherapy is given while doing as little harm as possible to normal cells. Radical radiotherapy means using high doses of this treatment to try to cure cancer.

This treatment is used to treat muscle-invasive or locally advanced bladder cancer. It is given with chemotherapy or a treatment called carbogen and nicotinamide. You may be offered it instead of surgery to remove the bladder. This is called a cystectomy.

We have more information about making decisions about bladder cancer treatment.

Radiotherapy may also be given if advanced bladder cancer is causing symptoms such as pain or bleeding. This is sometimes called palliative radiotherapy.

Palliative radiotherapy aims to improve the symptoms. It is a shorter course of treatment than radical radiotherapy.

For bladder symptoms you usually have 3 to 5 treatments over a week. Sometimes, you will have 1 single treatment.

For bone pain symptoms you may only need 1 treatment. Or you may need up to 5 treatments. 

We have more information about treating advanced bladder cancer.

You have radiotherapy in the radiotherapy department at the hospital. Treatment is given as a series of short, daily treatments. It is usually given on weekdays (Monday to Friday).

You may have to travel to a hospital further away than your local hospital to have treatment.

Radiotherapy is always carefully planned by a team of experts. They will plan your treatment so it does as little harm as possible to normal cells. The radiotherapy will be aimed precisely at the cancer.

On your first visit to the radiotherapy department, you will usually have a CT scan of the area that is being treated. The information from the scan is sent to a planning computer.

Your radiotherapy team use information from this scan to plan:

• the dose of radiotherapy
• the precise area to be treated.

During your scan, you lie still on a narrow bed. This is sometimes called a table. If you feel uncomfortable, tell the radiographers so they can help. It is important that you are comfortable, because you need to be able to lie in the same position for all your radiotherapy treatment.

You may have some small, permanent markings made on your skin. The marks are about the size of a pinpoint. They are made in the same way as a tattoo. The marks help the radiographer make sure you are in the correct position for each session of radiotherapy.

These marks will only be made with your permission. If you are worried about them or already have a tattoo in the treatment area, tell your radiographer. They can discuss this with you.

The radiographer uses laser lights to position you for your radiotherapy treatment. These are not harmful to your skin.

You usually have radical radiotherapy for bladder cancer as an outpatient. Each treatment takes 10 to 15 minutes.

How often you have treatment may depend on your general fitness and other health conditions. The treatments are usually given once a day from Monday to Friday, with a rest at the weekend, for 4 to 7 weeks. 

If you are less fit, you may have 1 treatment a week for 6 weeks. Your radiotherapy team will explain how many treatments you will have and when you will have them.

At the beginning of each session of radiotherapy, the radiographer will make sure you are in the correct position and that you are comfortable. When everything is ready, they leave the room and the treatment starts.

The radiographers can see and hear you from outside the room. There is usually an intercom, so you can talk to them if you need to during your treatment.

Radiotherapy is not painful, but you will have to lie still for a few minutes during the treatment.

Your doctor, nurse or radiographer will talk about side effects with you. Tell them about any side effects you have during or after treatment. There are often things that can help.

Side effects may build up towards the end of your course of radiotherapy. After treatment finishes, side effects usually get better over a few weeks or months.

Radiotherapy to the bladder and nearby areas can cause the following side effects.

These may include:

• loose stools (poo) or diarrhoea
• cramping pains in your tummy (abdomen) or back passage (rectum)
• feeling you need to go to the toilet although your bowel is empty (tenesmus)
• passing mucus or blood when you empty your bowels
• sore skin around the back passage.

Your specialist may give you anti-diarrhoea drugs to help. Your nurse or radiographer may suggest making changes to your diet, such as reducing how much fibre you eat. It is important to drink at least 2 litres (3½ pints) of fluids a day.

These include:

• passing urine (peeing) more often than usual
• passing urine during the night
• a burning feeling when you pass urine (similar to a urine infection)
• a poor flow of urine
• a feeling that you are not able to wait when you need to pass urine
• leaking small amounts of urine (incontinence)
• blood in your urine.

Your doctor can give you medicines to help. They may also ask you for a urine sample to check if you have an infection. An infection is a common cause of symptoms and is easy to treat.

Drinking fluids will help. Try to drink around 2 litres (3½ pints) a day. Try to drink water instead of drinks that may irritate the bladder. These include:

• drinks containing caffeine, such as tea, coffee, drinking chocolate and cola
• alcohol
• fizzy drinks
• acidic drinks – for example, orange or grapefruit juice
• drinks with artificial sweeteners – for example, diet or ‘light’ drinks.

We have more information about tips for coping with bladder or bowel changes.

The skin in the area being treated may become red and sore or itchy. It may also become darker. Tell your radiotherapy team if you notice any skin changes. They can give you advice about looking after your skin.

Radiotherapy often makes people feel tired. Tiredness (fatigue) may get worse as treatment goes on. If you are having radiotherapy alongside other treatments, such as surgery or chemotherapy, you may feel more tired. But there are things you can do to help, such as:

• get plenty of rest
• do some gentle exercise, such as short walks
• eat a healthy diet and drink plenty of fluids
• ask others for help with everyday jobs.

After treatment finishes, you may continue to feel tired for weeks or months. If it does not get better, tell your cancer doctor or specialist nurse.

We have more information about coping with tiredness (fatigue).

Radiotherapy only affects hair in the area treated. You may lose some of your pubic hair. It usually grows back after treatment finishes. It may take several months to grow back, although it depends on the dose of radiotherapy you have. Sometimes, hair loss is permanent.

If you have chemotherapy with radiotherapy, the chemotherapy drugs may cause hair loss in other areas of the body, such as from your head. Your doctor or nurse will explain what is likely to happen. Some chemotherapy drugs cause all or most of your hair to fall out.

We have more information about hair loss.

Macmillan is also here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online.
• Visit our bladder cancer forum to talk with people who have been affected by bladder cancer, share your experience, and ask an expert your questions.