Urethral Cancer: Radiation Therapy

Radiation therapy uses high-energy particles or waves to kill cancer cells or to stop them from growing. It may be used to treat urethral cancer. If and how it's used depends on the type of urethral cancer and its location in your urethra.

There are 2 types of radiation that can be used to treat urethral cancer: External beam radiation and internal radiation therapy (brachytherapy). Sometimes both types of radiation are used together.

• External beam radiation. The energy rays come from a large machine and are focused inside of your body. They are aimed at the tumor.

• Internal radiation therapy (brachytherapy). A radioactive material is put right into or near the tumor. 

Radiation alone is sometimes the first choice to treat urethral cancer in people with a penis. But it's more often used before or after surgery. It may be used before surgery to shrink a tumor so it's easier to remove. After surgery, it is used to kill any cancer cells that may remain.

In people with a vagina, radiation alone may be a choice for some early stage cancers. It’s often given along with chemotherapy (chemo). This is called chemoradiation.

Certain chemo medicines help radiation therapy better kill cancer cells. So chemoradiation is often used to get better outcomes when treating more advanced urethral cancer or higher stage urethral cancers. Radiation may also be used before or after surgery for cancers that have spread to a large part of the urethra close to the bladder.

Deciding on a radiation therapy treatment plan

You’ll work with a radiation oncologist to make your treatment plan. This is a healthcare provider who specializes in treating cancer with radiation therapy. This provider decides:

• The goal of radiation therapy

• The type of radiation therapy you need and when you should get it, such as with or without chemotherapy or before or after surgery

• The dose of radiation you need

• How long you need treatment

It may help to bring a family member or friend with you to appointments. Make a list of questions and concerns you want to talk about. During your visit, ask what the goal of radiation therapy is. Also ask what you can expect to feel during and after the treatments.

What to expect during radiation therapy

External radiation

External radiation is often given once a day, 5 days a week, for a set number of weeks.

Each treatment is like getting an X-ray. The radiation comes from a large machine. The machine doesn't touch you during the treatment. The treatments are quick and don't hurt.

You will have a session called simulation before your first radiation treatment. This visit is needed to find out exactly where on your body the radiation beam needs to be aimed. It may take a few hours. Imaging scans will be done. Small marks of permanent ink or tiny tattoos may be put on your skin to mark the treatment area. This helps the team be sure that the radiation is focused on the tumor and limits damage to healthy parts of your body.

On the day of treatment, your radiation therapist will carefully put you into the right position. You may see lights from the machine lined up with the marks on your skin. These help the therapist know you’re in the right position. The therapist will leave the room while the machine sends radiation to your tumor. During this time, they can see you, hear you, and talk to you. When the machine sends radiation to your tumor, you’ll need to be very still, but you don't have to hold your breath. Treatment takes only a few minutes, and the whole process will likely take less than an hour.

Brachytherapy

In this treatment, your healthcare provider puts a radiation source like tiny radioactive seeds or pellets or radioactive wires into or near the tumor. This is often done by putting the radiation source into a thin tube that's put in your urethra. The radiation the source gives off travels a very short distance. This helps make sure it affects the cancer cells with very little effect on nearby healthy tissue.

Brachytherapy might be used for people with a vagina who have tumors that are close to the outside opening of the urethra. It may be used if these tumors haven't spread deeply in the wall of the urethra or the tissues around it. It's seldom used in people with a penis.

There are different ways to give brachytherapy. Talk to your radiation oncologist to find out what you can expect.

Side effects of radiation

Talk with your healthcare provider about what you might feel like during and after radiation. All cancer treatments have side effects. Side effects often get worse as treatment goes on, but they can be treated. Most side effects get better or go away over time after treatment ends.

Side effects of radiation can include:

• Nausea

• Diarrhea

• Skin irritation. This can lead to redness, dryness, and soreness.

• Bladder pain

• Burning feeling when peeing

• Peeing more often or a more urgent need to urinate

• Urinary incontinence (unable to control your pee)

• Rectal pain and bleeding

• Vaginal pain and bleeding

• Extreme tiredness (fatigue)

• Hair loss in only the area being treated

• Narrowing of the urethra

• Urethral fistula

In most cases, these side effects go away after treatment. Many side effects can be managed with medicines.

Some side effects may last a long time. These can include urethral or vaginal strictures (narrowing caused by scar tissue build up). This may need surgery or dilatation (gentle stretching to open it). Some long-term side effects of radiation may not show up until many years after treatment. These depend on the dose and type of radiation. They also depend on how many times you had treatment.

Talk with your provider about what side effects you can expect. Ask what can be done to prevent or ease them. Ask your provider what symptoms to watch out for. In some cases, you should call your healthcare team. They may want you to call if you have signs of infection, such as fever or pain that gets worse. Be sure you know what number to call and what to do if you need help after office hours, on weekends, and on holidays.