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What do you need to know?

This page aims to offer information to patients who will be receiving a course of radiotherapy for bladder cancer. It provides details about the planning and treatment process and advice on how to deal with side effects. It is important to remember that the effects of radiotherapy differ for each individual, and depend, amongst other factors, on the dose of radiotherapy received and the period of treatment. If you are still unsure or have any further questions once you have finished reading this leaflet, please speak with a Therapy Radiographer who will be able to advise you on what to expect.

Your first appointment

When you first attend a Spire Specialist Care Centre a Therapy Radiographer will explain the treatment process and will discuss with you any possible side effects and how we can help you to manage them during and after radiotherapy.

Your first appointment at the centre will be to develop an individual treatment plan for you, and will involve a CT scan. Immediately prior to your CT scan, and each subsequent treatment, you will be asked to empty your bladder. The purpose of this is to ensure that the bladder is as small as possible and in a stable position. You will need to undress from the waist down (although underwear can stay on) and to get into a comfortable treatment
position which you will be able to replicate at future appointments. This will involve you lying on your back with your feet and knees supported by an adjustable immobilisation system.


Once you are in a stable and comfortable position the CT scan will be performed. As mentioned above, the purpose of this first scan is purely to plan your radiotherapy treatment. Our radiographers will need to make some small set up marks on your body to ensure that your position is replicated in daily treatment. Three small freckle sized dots are required, which, with your permission, we would like to make into permanent tattoos.

Once the scan has been completed you will be free to leave until you return for your next appointment which will be the start of your radiotherapy treatment.

Radiotherapy Treatment

The radiographers will ask you to lie on the couch in the same position you were in at the CT planning appointment and using the same immobilisation equipment. Using your set up marks, the radiographers will align you for treatment. When you are in the correct position the radiographers will inform you that they are leaving the room and you will be asked to remain as still as possible and breathe normally. The radiographers will be watching you on closed circuit cameras and can speak to you via an intercom system. A scan will be performed prior to delivering any treatment to ensure that you are in the correct position and any adjustments will be made if necessary. Treatment is painless; the radiotherapy machine will move around you but will not touch you. You cannot see or feel the treatment taking place but you will hear a buzzing sound, treatment takes a couple of minutes to deliver and once over you are free to leave the department.

Short term side effects

Dysuria

Following treatment, you may experience some pain when passing urine (this is known as dysuria). This is a common side effect of radiotherapy to the bladder and is a result from the bladder becoming inflamed from the treatment. However, occasionally, patients can develop a urine infection which may also be a cause of the pain (see below). You should always be able to pass urine, although your flow may be reduced. If you experience pain, or feel that your flow changes significantly, or you cannot pass any urine, then you should tell one of the radiographers as soon as possible.

Cystitis

With radiotherapy, the lining of the bladder can become irritated. It may already be difficult for you to fully empty your bladder even before you start treatment. If you notice any pain or stinging when passing urine, please let the radiographers know as soon as possible. They may ask you to provide a urine sample to exclude or confirm an infection. This is a normal course of action to take. Should the results show an infection, your Oncologist may prescribe you a course of antibiotics to treat the infection.

Increasing your fluid intake (even though this may mean you are passing urine more frequently which we understand is difficult if it is painful) helps dilute the urine and keeps the bladder functioning. There may be some analgesics which you can take to help with any discomfort when passing urine, and the radiographers will discuss this option with you, if applicable. Try to avoid caffeinated drinks or alcohol if you are experiencing cystitis symptoms, to avoid further irritation to your bladder.

Haematuria

You may already be experiencing blood in your urine from your irritated bladder, do not worry if this increases slightly during treatment, but please speak to one of the radiographers who will monitor this.

Diarrhoea

Radiotherapy can affect your bowels by making them work faster. This can lead to you needing to open your bowels more frequently. Sometimes this can progress to diarrhoea like symptoms, where motions may become loose and arrive with a sense of urgency. You should tell the radiographers looking after you if you experience the onset of diarrhoea, and they can discuss with you possible changes to your diet or medication that may help alleviate these symptoms.

It is important to drink plenty of fluids to help replace those lost. Occasionally you may pass some blood in your stool; this can be normal but please make the radiographers aware. 

Fatigue

Fatigue is a very common side effect of radiotherapy treatment. Tiredness and fatigue usually occurs towards the end of treatment and is a normal reaction. Fatigue may even continue for several weeks after your radiotherapy has finished. Again, this is a normal reaction and nothing to worry about it is usually caused by a combination of travelling to and from hospital, the effect of the treatment on your body, coping with the stress of a diagnosis of cancer, and continuing with normal life.

Skin 

The treatment area of your skin may become irritated. Whilst skin reactions are not a common side effect when receiving radiotherapy to the pelvis, your skin will be monitored daily by your team of radiographers and recommended creams and advice will be given to you when appropriate.

Long term side effects

Haematuria

After radiotherapy, small blood vessels in the bladder lining may be more fragile and bleed easily. This can cause blood in your urine.If you continue to see blood in your urine following treatment we may need to perform a cystoscopy to investigate the cause.

If there is only a small amount of bleeding that has been caused by radiotherapy you may not need any further treatment. If you are experiencing regular, heavy bleeding, or you become anaemic (a lack of red blood cells) it is likely you will need further treatment to address the cause.

Dysuria

Radiotherapy can make the urethra (the tube that drains urine from the bladder) narrow. This is called a urethral stricture. You may have difficulty passing urine or find yourself straining to release it.

If you are having problems passing urine it is important to get checked out by your doctor. If urine builds up in the bladder it can cause infections and damage the kidneys. Your doctor may carry out tests to identify the cause, so you can be offered the right treatment
for your situation. 

Diarrhoea

Long term bowel damage as a result of radiotherapy is uncommon, but would usually cause ongoing diarrhoea. Symptoms are generally mild but occasionally people need to have further treatment.