Radiotherapy is the use of exact, carefully measured doses of radiation to treat disease (mainly cancer).

It works by directing high energy x-rays at the tumour in order to destroy any abnormal cells that may be there. These abnormal cells are more sensitive to radiotherapy than normal cells and so will be destroyed. Normal cells within or close to the treated area will also be affected and this can cause treatment effects but the cells are usually able to recover. The radiotherapy is given to try and kill the cancer cells and reduce the risk of the cancer returning.

Radiotherapy for bladder cancer is usually given from outside of the body (external beam radiotherapy). The number of radiotherapy treatments received and their frequency will depend on the extent, size and type of the tumour. Radiotherapy treatment is painless and will not make you radioactive. 

It is very important that female patients tell their oncologist immediately if they suspect they may be pregnant.

Radiotherapy can be used for a number of different reasons in bladder cancer:

• Potentially curative radiotherapy (radical radiotherapy). This is usually given over a four to six and a half week period, with treatment usually given as an outpatient for five days a week (Monday to Friday). The treatment is painless and takes about 20 minutes
• Non curative (palliative) radiotherapy This may be given to help control symptoms such as blood in the urine or to slow the growth of the bladder cancer but is not likely to cure patients.

There are a number of different people involved in radiotherapy treatment. Radiographers are the team members who deliver the treatment on a daily basis.

Planning radiotherapy

The radiotherapy treatment has to be carefully planned so that you get the maximum benefit from the treatment.

Your first visit to the radiotherapy department will be to design the treatment and is likely to involve a special type of CT scan called a planning scan. This can only be done in a radiotherapy department and is additional to any other scan you may already have had.  Before the treatment is planned, you will be asked to sign a consent form, if you have not already done so.  

Immediately before this scan, you may be asked to empty your bladder fully. It may be necessary for you to remove some clothing to allow the radiographers to see the treatment area but they will try to keep you as covered as possible.  The scan is painless and this appointment takes about 20 minutes.   It is important you lie as still as you can throughout the procedure.

During the procedure, the radiographers may draw some marks onto your skin and may ask your permission to make some of these marks permanent with a small needle. These tiny permanent marks, together with measurements taken at this planning appointment, will ensure the pinpoint accuracy of your treatment on a day-to-day basis.

Some patients do not have a planning scan but attend the simulator in radiotherapy for their planning. This means that other types of pictures are taken at this appointment rather than a CT scan, to help design the treatment.

After the planning appointment, you will be given a list of dates and times for your treatment. Treatment usually starts as soon as possible but some treatments require detailed planning and take several days to prepare.

There is no medical reason why patients cannot drive during a course of radiotherapy treatment and there is no risk to family members from close contact with the patient.

Your doctor will discuss adding additional treatment (radiosensitiser) to the radiotherapy to make the radiotherapy work better. This radiosensitiser can be chemotherapy through a drip, tablets or a special form of oxygen, all of which are given during the radiotherapy. Each hospital will have decided which radiosensitiser it will use. As well as making the radiotherapy work better on the cancer, the radiosensitiser can decrease the risk of effects from the radiotherapy as well as a risk of infection and bleeding.

Adding the radiosensitiser to the radiotherapy can make a significant difference to results, however, for some patients the doctors may recommend radiotherapy on its own if there are reasons why a radiosensitiser is inappropriate.

Effects of radiotherapy: early reactions

1.       Fatigue
Tiredness is very common - as radiotherapy can damage normal tissues close to or in the treated area, your body will use a great deal of energy to repair these damaged cells. If you feel fit enough, gentle exercise can help.  But don't force yourself to do things you haven't the energy to do.

2.       Bladder symptoms
You may experience changes in the flow of your urine, a need to pass urine more often, a need to pass urine urgently, a burning sensation on passing urine and /or a small amount of blood in your urine.

Your consultant may be able to prescribe you something to help with these symptoms. Drink plenty of water based fluids such as squash or cordial. Tea and coffee can make the symptoms worse. Some people find cranberry juice helpful. Please tell the radiographers about any of these symptoms so that they can ensure you do not have an infection. Always report any difficulty in passing urine to the staff.

In the long term (months or years after radiotherapy), 1 in 20 patients will notice some minor changes with their bladder function. It is rare for this to make life more difficult for you but that can happen for a minority of patients. The bladder usually works well after radiotherapy although some patients find it holds less urine and they may need to urinate more frequently or have some urgency. A minority of patients will need an operation because of damage to the bladder caused by radiotherapy however this is very rare. Radiotherapy can also cause some blood in either the urine or bowels in the long term and this should always be mentioned to your consultant.

3              Bowel symptoms
Treatment may irritate your bowel and you might need to go to the toilet more often. Medication such as Fybogel may be prescribed for you. You may develop tenesmus, which is an urge to open your bowels without passing anything. This can feel like constipation. You may notice an increase in the amount of wind you pass. If opening your bowels becomes painful or you notice some spotting of blood tell the radiographers. These effects are common. Please do not modify your diet without discussing it with a consultant or radiographer.

In the long term, 1 in 20 patients may notice some minor changes with their bowels with increased urgency or frequency. Medication can usually be given to help with this. It is very rare to need an operation to correct damage caused to the bowel by radiotherapy.

4              Sore or red skin (erythema)
Radiotherapy can make the skin in the treated area become itchy, red and sore, although this is rare.  There are some things you can do to help this:

• Wear loose fitting clothing made of natural fibres such as cotton
• Wherever possible allow air flow to the area
• Protect the affected area from the extremes of heat or cold
• Avoid activities such as swimming where the chemicals may irritate your skin
• Do not allow the affected area to be exposed to the sun
• Bathing and showering is allowed, but when washing the treatment area use water which is not too hot or too cold
• Avoid wet shaving in the treatment area.
• Wash only with "simple" or baby soap and do not use shower gels, bath products or deodorants in the treatment area.
• Gently pat the skin dry with a soft towel after bathing. Do not rub the skin
• You may find that applying aqueous cream or E45 cream onto the treatment area twice a day will help. The cream can be stored in the fridge to soothe warm inflamed skin
• Do not use any creams on pelvic skin reactions without first checking with a member of your treatment team.

If you've had radiotherapy the skin will take some time to recover after treatment finishes.   In the first two weeks after radiotherapy, reactions may get worse before improving.  Skin in the treatment area will be more sensitive to sun exposure in the future and it is important to use a high factor sun block to protect your skin.

If you have any questions regarding skin care you can contact your specialist nurse or the radiotherapy department for advice.

Radiotherapy to the lower abdomen in younger women will induce the menopause. A reaction called vaginal stenosis may occur as a result of scar tissue forming after radiotherapy. Vaginal dilators can be given to those having radiotherapy to try to prevent this from happening.

Lack of semen or reduced sperm count in males may result in infertility.