Bladder Cancer Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Like surgery, radiation therapy is local therapy. It affects cancer cells only in the treated area.

A small number of patients may have radiation therapy before surgery to shrink the tumor. Others may have it after surgery to kill cancer cells that may remain in the area. Sometimes, patients who cannot have surgery have radiation therapy instead.

Doctors use two types of radiation therapy to treat bladder cancer:

• External radiation: A large machine outside the body aims radiation at the tumor area. Most people receiving external radiation are treated 5 days a week for 5 to 7 weeks as an outpatient. This schedule helps protect healthy cells and tissues by spreading out the total dose of radiation. Treatment may be shorter when external radiation is given along with radiation implants.
• Internal radiation: The doctor places a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen. The patient stays in the hospital for several days during this treatment. To protect others from radiation exposure, patients may not be able to have visitors or may have visitors for only a short period of time while the implant is in place. Once the implant is removed, no radioactivity is left in the body.

Some patients with bladder cancer receive both kinds of radiation therapy.

These are some questions a patient may want to ask the doctor about radiation therapy:

• Why do I need this therapy?
• How will the radiation be given?
• Will I need to stay in the hospital? For how long?
• When will the treatments begin? When will they end?
• How will I feel during therapy? Are there side effects?
• What can I do to take care of myself during treatment?
• How will we know if the radiation is working?
• Will I be able to continue my normal activities during treatment?
• How often will I need checkups?

The side effects of radiation therapy depend mainly on the treatment dose and the part of the body that is treated. Patients are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

External radiation may permanently darken or "bronze" the skin in the treated area. Patients commonly lose hair in the treated area and their skin may become red, dry, tender, and itchy. These problems are temporary, and the doctor can suggest ways to relieve them.

Radiation therapy to the abdomen may cause nausea, vomiting, diarrhea, or urinary discomfort. The doctor can suggest medicines to ease these problems.

Radiation therapy also may cause a decrease in the number of white blood cells, cells that help protect the body against infection. If the blood counts are low, the doctor or nurse may suggest ways to avoid getting an infection. Also, the patient may not get more radiation therapy until blood counts improve. The doctor will check the patient's blood counts regularly and change the treatment schedule if it is necessary.

For both men and women, radiation treatment for bladder cancer can affect sexuality. Women may experience vaginal dryness, and men may have difficulty with erections.

Although the side effects of radiation therapy can be distressing, the doctor can usually treat or control them. It also helps to know that, in most cases, side effects are not permanent.