Radiotherapy for invasive bladder cancer

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

But radiotherapy is not recommended if

• You have squamous cell bladder cancer
• You have CIS in much of the bladder lining as well as invasive cancer
• Your cancer does not respond to initial chemotherapy
• Both of 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 it may have less effect on your sexual function. But, radiotherapy can cause short term and long term side effects for some people.

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, but the exact dose and length of treatment will need to be decided by your own doctor.

Your specialist carefully plans your radiotherapy treatment. The aim is to include all tissues that could possibly include cancer cells, while avoiding as much healthy tissue as possible.

On your first visit to the radiotherapy department, you lie under a large machine called a simulator or a CT scanner. This takes normal X-rays of your body so your doctor can work out exactly where you need to treatment. Marks will be made on your skin during the planning session. Your radiographer will use these skin marks to line up the radiotherapy machine every day when you have your treatment. So it is important not to wash them off.

Each treatment only takes a few minutes. The radiographer will position you on the couch and make sure you are comfortable. Then the radiographer will go out of the room while you have your treatment. They will still be able to hear and see you through an intercom.

Radiotherapy does not hurt. You will not be able to feel it. But you will have to lie very still for a few minutes during the treatment. And it doesn't make you radioactive. It is perfectly safe to be with other people, including children, throughout your treatment course.

Look at the main radiotherapy section for more information about radiotherapy and side effects. There is a section about stomach and abdominal side effects of radiotherapy that you may find helpful.

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 (a bladder infection). 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 about them in case you do have an infection that needs antibiotic treatment.

If you have diarrhoea your doctor can give you anti diarrhoea tablets, such as loperamide or codeine. There is information about managing diarrhoea in the section on coping physically with cancer.

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 may have some short or long term effects on your sex life. You can read about these in the sex, sexuality and cancer section.

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 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.

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. 

There is more about how radiotherapy affects sex and fertility for men and women in the radiotherapy side effects section.

The cancer comes back in the bladder lining in 40 to 50% of people who have 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. There is more about surgery for invasive bladder cancer in this section of CancerHelp UK.

Look at the main main radiotherapy section. It tells you more about this type of treatment including

• What radiotherapy involves
• Treatment planning
• Possible side effects

Our bladder cancer organisations page has details of information services you can contact for more information about cancer and its treatment. Our bladder cancer reading list has details of helpful books and booklets, some of which are free.