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Radiotherapy for invasive bladder cancer

 Men and women discussing bladder cancer

This page tells you about radiotherapy treatment for bladder cancer. Radiotherapy uses high energy rays to kill cancer cells. You can find information about


A quick guide to what's on this page

Radiotherapy for invasive bladder cancer

Radiotherapy uses high energy rays to kill cancer cells. Your specialist may suggest radiotherapy instead of surgery if you want to try to keep your bladder, or try to keep your ability to have an erection. If your cancer comes back in your bladder after radiotherapy, your doctor will probably recommend that you have your bladder removed (cystectomy).

Having your treatment

You have radiotherapy in the hospital radiotherapy department. Treatments are usually once a day, from Monday to Friday, for up to 6 or 7 weeks. Each treatment only takes a few minutes. You may have chemotherapy at the same time (concomitant chemoradiotherapy). You may also have chemotherapy before the radiotherapy.

Side effects

Radiotherapy generally causes tiredness and sore, red skin in the treated area. It can also irritate the bladder and bowel. This can cause a need to pass urine very often, pain when passing urine and bowel problems, usually diarrhoea. 

Drinking plenty of water will help with bladder symptoms. Your doctor or nurse may be able to give you anti diarrhoea tablets.

Side effects usually last a few weeks after your treatment is over. A few people have long term side effects. Radiotherapy for bladder cancer can also affect your ability to have children (fertility).


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Radiotherapy for bladder cancer

For many people with invasive bladder cancer, radiotherapy works as well as surgery at curing it. Doctors may recommend you have chemotherapy at the same time as the radiotherapy. This is called concommitant chemoradiotherapy. You may also have chemotherapy before starting the course of chemoradiotherapy.

But radiotherapy is not recommended if

  • You have squamous cell bladder cancer
  • You have carcinoma in situ (CIS) in much of the bladder lining as well as invasive cancer
  • Your cancer does not respond to initial chemotherapy
  • The tubes that take urine from the kidneys into the bladder (ureters) are blocked

If you have radiotherapy, you don't need to have your bladder removed and it causes less damage to nerves in the genital area. So this may have less effect on your sexual function. But, radiotherapy can cause short term and long term side effects for some people.


Radiotherapy and chemotherapy together

For chemoradiotherapy, you have external radiotherapy and chemotherapy at the same time. The drugs you have are called radiosensitisers. This means the chemotherapy drugs make the radiotherapy work better.

Most often, you have 2 drugs called fluorouracil (5FU) and mitomycin. But doctors can use other chemotherapy drugs, such as gemcitabine. 

For fluorouracil and mitomycin, you usually have an injection of mitomycin into your vein on the first day of radiotherapy. You also start a drip (infusion) of fluorouracil that lasts for 5 days. You may have this through a PICC line, and go home with it. PICC lines are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your course of treatment starts and it stays in place as long as you need it.

You continue to have radiotherapy on every week day for around 6 weeks, depending on your hospital. At the beginning of the fourth week of your radiotherapy treatment you have another 5 day drip of fluorouracil.

You may also have chemotherapy before starting the course of chemoradiotherapy. This is called neoadjuvant chemotherapy, and you usually have different chemotherapy drugs. The aim of neoadjuvant chemotherapy is to treat any cancer that may have spread outside the bladder.


Where and when you have radiotherapy

You have radiotherapy treatment in the hospital radiotherapy department. Usually, treatments are once a day, from Monday to Friday, with a rest at the weekend. 

Radiotherapy to cure bladder cancer can be quite a long course. It may be up to 6 or 7 weeks. The exact dose and length of treatment is decided by your own doctor.


Planning your treatment

Before you begin your treatment, the radiotherapy team carefully plan your external beam radiotherapy. This means working out how much radiation you need to treat the cancer, and exactly where you need it. 

You may need to empty your bladder before you have the scan. If you do, then you may have to do this before every treatment. The radiographers go through this with you.

Your planning appointment may take from 15 minutes up to a couple of hours. You will have a planning CT scan. The scan shows the cancer and the structures around it.

CT scanner

You lie on the scanner couch with the treatment area exposed. The radiographers will put some markers on your skin. You need to lie very still. Once you are in position the radiographers move the couch up and through the scanner. The scanner is a doughnut shape. 

The radiographers leave the room and the scan starts. It takes up to 5 minutes. You won't feel anything. The radiographers watch from the next door room.

Before the planning appointment you may also have other scans, such as MRI scans or PET scans. Your treatment team can feed the other scans into the planning scanner.

Ink marks

Once the treatment team has planned your radiotherapy, they may put ink marks on your skin to make sure they treat exactly the same area every day. They may also make pin point sized tattoo marks in these areas.

After your planning session

You may have to wait a few days or up to 2 weeks before you start treatment. During this time the physicists and your radiotherapy doctor decide the final details of your plan. 

Your doctor will plan the areas that need treatment and outline areas to limit the dose to or avoid completely. They call this contouring. Then the physicists and staff called dosimetrists plan the treatment very precisely, using advanced computers.


Having radiotherapy treatment

Radiotherapy machines are very big. The machine may be fixed in one position or able to rotate around your body to give treatment from different directions. Before your first treatment, your radiographers will explain what you will see and hear. The treatment rooms usually have docks for you to plug in music players. So you can listen to your own music.

You can't feel radiotherapy when you actually have the treatment. It takes anything from 15 to 30 minutes. It is important to lie in the same position each time, so the radiographers may take a little while to get you ready.

A photo of a linear accelerator, which gives radiotherapy

Once you are in the right position the staff leave you alone in the room for the treatment. They watch you carefully on a closed circuit television screen.

Our page about having external radiotherapy has a video about having radiotherapy that you may want to watch.

Radiotherapy doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.


Side effects

Generally, radiotherapy causes tiredness and sore, red skin in the treated area. When you have it for bladder cancer, radiotherapy can irritate the bladder and nearby bowel and cause particular symptoms. These are

  • Pain passing urine
  • The need to pass urine very often
  • Bowel disturbances, usually diarrhoea

You may feel as if you have cystitis (bladder inflammation). Try to drink plenty of fluids as this will help. The symptoms will gradually get better on their own within a few weeks of your treatment finishing. But you should tell your doctor or radiographer about them in case you have an infection that needs antibiotic treatment.

If you have diarrhoea your nurse or radiographer can give you anti diarrhoea tablets, such as loperamide or codeine.

Side effects usually last for some weeks after your treatment is over. Tiredness can last for some months, but will gradually wear off. You may find that the radiotherapy has some short or long term effects on your sex life.


Long term side effects

A year or two after their radiotherapy treatment, some people develop permanent side effects. You may find that

  • Your bladder shrinks slightly, so you need to pass urine more often (this is rare)
  • You have blood in your urine
  • You have damage to the bowel

You may have blood in your urine because small blood vessels can grow on the surface of the bladder. This is called telangiectasia. Having blood in your urine can be very worrying. You may think it is the cancer coming back. You must tell your doctor or nurse straight away so that you can have a check up and rule that out. If the bleeding is caused by the radiotherapy, it is usually only slight and is nothing to worry about.

Long term bowel damage is uncommon but usually causes diarrhoea. Symptoms are generally mild but occasionally people need to have further treatment.

Most people do not have bad side effects and find their bladder works well after radiotherapy.


Fertility and radiotherapy

Because the bladder is near the reproductive organs, radiotherapy to this area usually means that you can no longer have children after treatment. 

Men may have lowered sperm counts. Women who have not yet had their menopause may find that they have an early menopause due to the effect of the radiation on the ovaries. If you are worried about this, talk to your radiotherapy specialist before your treatment begins.


If the cancer comes back

Sometimes the cancer can come back in the bladder lining after radiotherapy. If your cancer comes back and hasn't spread anywhere else in the body, your doctor will probably then recommend that you have your bladder removed (cystectomy). The aim of this treatment is to try to cure your cancer.


More about radiotherapy

Find out about

Different types of bladder cancer

Radiotherapy side effects to the stomach and abdomen

PICC lines

Chemotherapy types - Mitomycin, Fluorouracil (5FU) and Gemcitabine

Bladder cancer organisations page

Bladder cancer reading list

For general information and support

Contact the Cancer Research UK nurses on freephone 0808 800 4040 (Open 9am - 5pm, Monday to Friday)

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Updated: 1 July 2015