Radiotherapy to the Bladder

  • Reference Number: HEY-193/2018
  • Departments: Radiotherapy

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This booklet has been produced to give you general information about radiotherapy to the bladder, in addition to the information you will receive from your Clinical Oncologist.

The bladder sits on the pelvic floor and is a hollow, muscular balloon-like organ that collects and stores urine. Urine enters the bladder via the ureters and exits via the urethra, (Fig 1).

Diagram of Bladder position
Fig 1: Diagram of Bladder position.

Radiotherapy is the use of high energy X-rays and other types of X-rays (e.g. electrons) to treat cancer. Radiotherapy works by causing chemical and physical damage to the cancer cells in the treatment area. Although some normal healthy cells are also affected during radiotherapy, these are able to recover and repair themselves over time.

Radiotherapy can be used for a number of different intended benefits. For example, radiotherapy can be used as a curative form of treatment following surgery, or used as symptom control. Radiotherapy does not make you radioactive and you are safe to be around all people including children whilst you are on treatment.

The Clinical Oncology Consultant you are under will have already discussed the treatment, side effects and gained your consent for you to proceed with your radiotherapy treatment. There are several stages prior to you actually commencing your treatment.

Planning your treatment

Your first appointment in the Radiotherapy Department will be a planning appointment. This appointment will be approximately 30 minutes in duration.

A member of the radiotherapy team will speak to you before any procedure is carried out to obtain your consent for this localisation process. A specialist X-ray machine called a CT (Computed Tomography) scanner will be used as part of the planning process. This machine enables us to obtain images of the area of interest whilst you lie on the CT couch, you will move backwards and forwards through the hole of the machine very slowly, pictured, (Fig 2), and you will not feel anything at all.

CT scanner
Fig 2: CT scanner.
Image from Radiotherapy Department Patient Information.

In the CT room, you will have to loosen or remove your clothing only in the area of interest (i.e. the lower body) and then you will be helped into the correct position on the couch. We will then draw some temporary markings onto your pelvis area. The staff will then leave the room to perform the scan. Upon returning, three or four permanent markings will replace the temporary marks; this is done by using a sterile needle and ink. These marks will only be the size of a freckle and allow the radiotherapy staff to accurately align and reproduce the correct position daily for treatment.

The information obtained from this scan is used to produce your individual treatment plan. The CT staff will confirm your treatment start date before you leave the department.

Radiotherapy treatment – what happens on the first day?

On your first day, and each day afterwards, when you attend please book in at the radiotherapy reception desk. You will be asked to take a seat either in the main waiting area or directed to a specific waiting area. A radiographer will come and talk with you to go through the possible side effects of treatment and answer any questions or concerns you may have.

What happens during treatment?

Radiotherapy is painless and usually takes 10 – 15 minutes to deliver, by a machine called a Linear Accelerator (Fig 3) or Linac, for short.

Linear Accelerator (Linac)
Fig 3: Linear Accelerator (Linac).
Image from Radiotherapy Department Patient Information.

We do require your bladder to be empty for every daily treatment session. Furthermore, your bowels also need to be emptied prior to your daily treatment. If your consultant has prescribed you any laxatives/suppositories (i.e. rectal suppositories or Movacol®), please continue to take as advised. Both these requirements are very important for the accuracy of your treatment.

A member of staff will escort you into the treatment room. A curtained private changing area is available should items of clothing need to be removed, maintaining your privacy at all times.

The radiographers will then assist you into the correct treatment position on the couch. This will be the same position you were in for your CT planning appointment. The radiographers will then move the Linac into position, ready for treatment. The radiographers are controlling the Linac at all times and the machine may seem close to you but it will not touch you. Once you are set up in the correct position, the staff will let you know that they are leaving the room and then leave for a few minutes to commence treatment.

The machine is being controlled by the staff outside in the control area and will rotate around you in different directions. The radiographers are watching you at all times on the TV monitors, and should you feel you want to stop the treatment at any time just wave to attract their attention, the machine will stop and the radiographers will come back into the room. You will not feel or see anything during your treatment; however you may hear a buzzing sound when the treatment is being delivered.

Reviews during treatment

You will have regular weekly reviews with a radiographer as you progress through your treatment to assess how you are coping with any side effects and your general well-being. You may be referred to one of our nursing team if further medical advice or intervention is required.

Side effects of treatment

You may experience some side effects and reactions as you progress through your treatment. Every individual is different and as such you may experience some and at varying times and levels. This is normal and temporary so please do not worry. You can speak to your Radiography team regarding how you can control them and/or if your symptoms worsen, we can advise and treat you accordingly.

Listed below are some of the most common side effects experienced. These usually begin approximately 2 – 3 weeks into treatment and may continue for a short while after you have completed your radiotherapy but will then slowly settle down.

Some patients also receive weekly chemotherapy along with radiotherapy. The chemotherapy nurses will discuss the side effects caused by chemotherapy with you.

Urinary Problems

You may experience changes to your urinary symptoms. These include:

  • Burning or stinging sensation when you pass urine, also known as cystitis.
  • Passing urine more frequently, especially during the night (nocturia).
  • An increased urgency to pass urine – but unable to do so.

Following the steps below may help with the above symptoms:

  • Ensure that you are drinking enough fluid and increase if necessary. We recommend that you drink 8 glasses or 2 litres of water a day.
  • Try to limit/avoid smoking, drinking alcohol and caffeinated drinks (i.e. tea, coffee and cola) because they can make urinary problems worse as they can irritate the bladder.
  • Drinking a daily glass of cranberry juice may help prevent urinary infections, though you should NOT if you are taking Warfarin. Please ask your doctor or nurse to check the results of your last blood test before having cranberry juice.

Bowel Problems

Changes in your bowel habits/motions may occur as radiotherapy may irritate the bowel. These can include:

  • Loose motions/diarrhoea. This can easily be treated with medication such as Imodium®.
  • The urge to want to open your bowels more frequently but without passing anything (tenesmus) or only a small stool/mucus.

We do not recommend you alter your diet drastically in any way but if you do begin to experience any of the above symptoms speak to a radiographer or nurse who will be able to advise you.

Skin Reactions

Sometimes radiotherapy may cause skin in the treated area to become sore or pink, especially around the groin area and in between the buttocks. This is rare and advice will be given on how to care for your skin if this does happen and cream may be supplied. It is also possible you will lose the hair within your pubic region.

Fatigue/Tiredness

Some patients may experience feeling more tired than usual during treatment. This could be due to having to get up several times during the night or travelling a long way for daily treatment. Be sensible and rest when you feel the need too. Normal energy levels will return around one month after your treatment has finished.

Late side effects

With the use of modern planning techniques, we aim to reduce the chance of late side effects from happening. Late side effects may occur some months or even years after completion of treatment.

Bladder

  • Incontinence (unable to hold as much urine as previously).
  • Urinary frequency due to smaller bladder capacity.
  • Thinning of the lining of the bladder.

Bowels

  • Diarrhoea or more frequent bowel movements (a common side-effect).
  • Narrowing of the bowel.
  • Bleeding from the rectum (contact your Clinical Oncologist).
  • Inflammation of the lining of the rectum (proctitis) causing bleeding from the back passage (contact your Clinical Oncologist).

Impotence (difficulties in getting an erection)

  • This may be due to radiotherapy, hormone treatment or surgery and occurs in 50% of men. If this problem continues, please consult your doctor.

Infertility

  • Most treatments for cancer cause infertility. You may wish to discuss this further with your consultant prior to radiotherapy.

For women

  • Vaginal narrowing and dryness may occur. Please consult your doctor if this is a problem.

Post radiotherapy treatment

Once you have completed your course of radiotherapy treatment, you will receive a follow-up appointment. This appointment will be sent to you in the post for you to see your Consultant Oncologist again at the hospital where you were first seen. This is usually around 4 – 6 weeks after treatment has finished, as time to allow any side effects experienced to settle down is required. Your Consultant will then decide if any further tests / appointments are necessary.

Advice and support services

Please read the information booklet. Share the information it contains with your partner and family (if you wish) so that they can be of help and support. There may be information they need to know, especially if they are taking care of you following this treatment.

Radiographers

These highly trained specialists help in several aspects of your treatment from CT and treatment. You will see where possible the same team of radiographers each day you attend for your treatment. They are there to help you if you have any problems or worries. Please feel free to speak to them regarding any help and advice. You may be referred to another member of the oncology team as necessary.

Radiotherapy Nursing Team

The team consists of registered nurses and Clinical Support Workers (CSW’s) who are based within the Radiotherapy Department. They actively support and advise patients receiving radiotherapy treatment. They are able to make appropriate referrals and offer advice to patients and their families/carers.

Health Centre

The primary aim of our Health Centre is to help patients and their families to have the best possible health and quality of life during and after treatment. The Health Centre is open to all oncology patients and their families and offering an informal atmosphere to those who wish to “drop in” to the centre. Specially trained staff are available to advise on different aspects of coping with cancer.

The centre is located in the Main Reception of the Queen’s Centre for Oncology and Haematology at Castle Hill Hospital. Opening times are Monday – Friday 9.00 a.m. to 5.00 p.m.

Below are the contact details of useful organisations that provide information about cancer including radiotherapy treatment.

Macmillan Cancer Support

Provides information from specialist nurses on all aspects of cancer and its treatment and on the practical and emotional aspects of living with cancer.

You can drop into the Macmillan Cancer Information Centre at the Queen’s Centre or call them on: (01482) 461154 (Monday – Friday 9.00 a.m. to 5.00 p.m.)

Alternatively free-phone the national help line: 0808 808 0000 (Monday – Friday 9.00 a.m. to 8.00 p.m.)

Online: http://www.macmillan.org.uk

Write to: Macmillan Cancer Support, 89 Albert Embankment, London, SE1 7UQ

PALS (Patient Advice and Liaison Service)

Provide confidential advice and support, helping you resolve any concerns you may have about the care we provide, guiding you through the different services available from the NHS.

Telephone: (01482) 623065 (Monday – Friday 9.00 a.m. – 4.00 p.m.)

Email: pals.hey@hey.nhs.uk

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Radiotherapy Information and Support Team on telephone number (01482) 461206, or Email: Radiotherapy.Info@hey.nhs.uk

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.