Bladder Cancer: Radiation Therapy

What is radiation therapy?

Radiation therapy uses high-energy beams of X-rays or other particles to kill cancer cells or stop them from growing. A large machine aims the beams of energy at the cancer.

To get this treatment, you’ll see a radiation oncologist. This healthcare provider specializes in treating cancer with radiation and works with you to make your treatment plan. The plan tells what kind of radiation you’ll have, the dose, and how long the treatment will last. Your healthcare provider can tell you what to expect during treatment. They can also tell you how you may feel during and after the treatment.

When is radiation therapy used for bladder cancer?

Radiation can be used as part of a combination of treatments or, less often, as the only treatment for people with bladder cancer. Your healthcare provider may suggest this treatment for any of the following reasons:

• To try to kill any cancer cells left after the tumor was removed. Radiation can be given after surgery is done to remove just the part of the bladder with the tumor (not your entire bladder). It's used to kill any cancer cells that may be left behind. In some cases, chemotherapy (chemo) is given along with the radiation. This is called chemoradiation.

• To try to shrink cancer before surgery. Radiation may be used before surgery to help shrink a tumor so that less of the bladder needs to be removed.

• To try to kill any cancer cells left after the bladder was removed. Radiation is sometimes needed after the bladder has been removed (radical cystectomy). It can help kill any cancer cells that might be left in the area.

• As the main treatment for bladder cancer. This is more likely in people who aren’t healthy enough to have surgery. If possible, chemo is given at the same time.

• To help ease symptoms. Radiation can be used to treat problems caused by a large tumor (such as bleeding or pain) or to treat tumors that have spread to other parts of the body (metastases).

How is radiation given?

Your radiation oncologist will work with other healthcare providers on your team (often a urologist and sometimes a medical oncologist). Radiation treatment is done by a specially trained radiation therapist.

Radiation to treat bladder cancer is called external radiation. The radiation comes from a machine. It’s aimed at the tumor from outside of your body. You can’t feel the radiation. It's a lot like getting an X-ray but takes longer. 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 each day.

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.

What happens during simulation

Before your first radiation treatment, you’ll have an appointment called simulation. This is needed to find exactly where on your body the radiation beam needs to be directed. It may take up to 2 hours. During this session, imaging tests, such as CT or MRI scans, may be done. These tests help your healthcare providers know the exact location of the tumor so they can aim the radiation right at it. Also at this session, you may have body molds made to put you in the exact same position and help keep you from moving during treatments.

Then, you’ll lie still on a table while a radiation therapist uses a machine to define your treatment field. The field is the exact area on your body where the radiation will be aimed. Sometimes it’s called your port. The therapist may mark your skin with tiny dots of semipermanent ink or tattoos. This is so the radiation will be aimed at the exact same place each time.

What happens during daily radiation treatments

On the days you get 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 is painless and takes about 15 to 30 minutes. You should plan on being there for about an hour total.

At the start of the treatment session, a radiation therapist helps you get into position and may use blocks or special shields to protect parts of your body from exposure to radiation. The therapist then lines up lights from the machine with the treatment field marked on your skin so the radiation is aimed at the right spot. Sometimes X-rays or CT scans are used to check alignment before each treatment.

When you’re ready, the therapist leaves the room and turns the machine on. You may hear whirring or clicking noises as the machine moves during radiation. This may sound like a vacuum cleaner. The machine won't touch you. During the session, you’ll be able to talk to and hear the therapist over an intercom. The therapist can see you the whole time. You can’t feel radiation, so the process will be painless. You will not 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. Side effects depend on the dose of radiation you get and the area that's treated. Side effects tend to only affect the part of your body that’s treated.

Common side effects can include: 

• Extreme tiredness (fatigue)

• Irritation, blistering, and peeling of the skin at the radiation site

• Bladder irritation which can lead to more frequent urination and burning with urination. You may wake up more at night to urinate. 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.

• 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)

• Mucus with bowel movements

• Ovary damage that can cause menopause and infertility. Hormone replacement may also be needed.

The side effects of radiation treatment can be unpleasant, but they usually aren’t dangerous. Most side effects go away over time after treatment ends. But some can lead to long-lasting damage. Talk with your healthcare team about side effects you might have. Find out what can be done to help prevent or treat them. 

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 healthcare provider says.

Talk with your healthcare team about what side effects to watch for and when to call them. Make sure you know what number to call with questions or problems. Ask if there is 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.