Intensity Modulated Radiation Therapy
IMRT, an advanced form of 3D-CRT therapy, is the most common type of external beam radiation therapy for prostate cancer. It uses a computer-driven machine that moves around the patient as it delivers radiation. Along with shaping the beams and aiming them at the prostate from several angles, the intensity of the beams can be adjusted to limit the doses of radiation reaching nearby normal tissues. This lets doctors deliver an even higher radiation dose to the cancer.
Some newer radiation machines have imaging scanners built into them. This advance, known as image guided radiation therapy , lets the doctor take pictures of the prostate just before giving the radiation to make minor adjustments in aiming. This appears to help deliver the radiation even more precisely and results in fewer side effects.
A variation of IMRT is called volumetric modulated arc therapy . It uses a machine that delivers radiation quickly as it rotates once around the body. This allows each treatment to be given over just a few minutes. Although this can be more convenient for the patient, it hasnt yet been shown to be more effective than regular IMRT.
Low Levels Of Vitamin B12
You might have low levels of a vitamin B12 deficiency after radiotherapy to the pelvis . This is called a vitamin B12 deficiency.
Radiotherapy can stop your digestive system taking in vitamin B12 from the food you eat. This is called malabsorption. This means you can have a B12 deficiency even if you eat a balanced diet.
A B12 deficiency can be a cause of anaemia. This can lead to a feeling of weakness, constipation or diarrhoea and numbness and tingling.
Its important that you go to your doctor if youre experiencing these symptoms so that they can help you.
Radiation Therapy For Prostate Cancer
Radiation therapy uses high-energy rays or particles to kill cancer cells. Depending on the stage of the prostate cancer and other factors, radiation therapy might be used:
- As the first treatment for cancer that is still just in the prostate gland and is low grade. Cure rates for men with these types of cancers are about the same as those for men treated with radical prostatectomy.
- As part of the first treatment for cancers that have grown outside the prostate gland and into nearby tissues.
- If the cancer is not removed completely or comes back in the area of the prostate after surgery.
- If the cancer is advanced, to help keep the cancer under control for as long as possible and to help prevent or relieve symptoms.
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Treatment Of Bladder Cancer By Stage
Most of the time, treatment of bladder cancer is based on the tumors clinical stage when it’s first diagnosed. This includes how deep it’s thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.
Radiation Treatment Is Ok
Aksnessæther emphasizes that they dont advise patients not to receive radiation.
“We see that 85 percent of cases of bladder cancer are superficial cancers, which the patient is unlikely to die from,” she says.
In today’s treatment regimen, a greater proportion of patients with local, advanced prostate cancer are treated surgically. But still, a good number of people receive radiation and hormone therapy. It is uncertain what gives the best results, and there is a Scandinavian study underway to investigate this.
We see that a fair amount of the patients who have been operated need radiation therapy afterwards because they have relapses the operation has not succeeded in removing all parts of the tumour. We look forward to receiving the results of this new study so that we can give even better advice to patients regarding choice of treatment, Aksnessæther said.
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Other Treatments For Bladder Cancer
For many early-stage bladder cancers, BCG is the best option for treatment. Other treatments for bladder cancer include:
- Surgery to remove the tumor: Early cancers can be removed with TURBT surgery. More advanced cancers may require more extensive surgery, like removal of part or all of the bladder .
- Intravesical chemotherapy: This treats the inside of the bladder with chemotherapy drugs. Chemotherapy drugs commonly used for bladder cancer include Mutamycin , Gemzar , or Valstar .
- Radiation therapy
- Clinical trials
What Is Bladder Cancer Recurrence
However, people who have been treated for bladder cancer sometimes develop recurrent bladder cancer. This is the term for cancer that has recurred, which means that the bladder cancer cells have started to grow again after the bladder cancer has been treated. Bladder cancer cells can recur in the bladder or they can recur in other parts of the body.
Some people who are treated for bladder cancer never have a recurrence. Although recurrence is not uncommon among people who are treated for bladder cancer, in many cases the recurrence can be treated effectively. This is especially true for non-invasive bladder cancer that is located in the lining of the bladder and has not grown into the muscle of the bladder walls.
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Radiation Therapy For Bladder Cancer
Radiation therapy, also known as radiotherapy, uses a controlled dose of radiation to kill or damage cancer cells. The radiation is usually in the form of x-ray beams.
On its own, radiation therapy can help to control bladder cancer. In this case, you may have a single session, or up to 20 sessions given Monday to Friday over four weeks. This approach may be recommended if you are too unwell for other treatments or if the cancer has spread to other parts of the body.
Radiation therapy can sometimes be combined with other treatments in trimodal therapy, with the aim of curing the cancer.
You will meet with the radiation oncology team to plan your treatment. During a radiation therapy session, you will lie on an examination table, and a machine will direct the radiation towards your bladder. The treatment is painless and cant be seen or felt.
Intraoperative Radiation Therapy During Bladder Cancer Surgery
Intraoperative radiation therapy is a treatment given during bladder cancer surgery to reduce the risk of the cancer returning. This approach delivers powerful radiation through thin tubes called catheters that are placed directly on the tissue. This can kill cancer cells that may remain after the tumor is removed. It is most commonly recommended if the cancer has spread beyond the bladder.
Because this treatment occurs during the surgery and can be delivered to a precisely defined area, it is possible to use a higher-than-usual dose of radiation. Normal tissue, especially the bowel, can be temporarily moved away from the treatment area or covered with shielding devices while radiation is delivered.
Intraoperative radiation treatment usually takes just a few minutes during the surgical procedure. Once the radiation dose is delivered, all radiation-related materials are removed and the operation continues.
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Prostate Cancer Patients Who Have Received Radiation Have More Than Twice The Risk Of Getting Bladder Cancer Compared To Those Who Received Only Hormone Therapy Nevertheless Radiation Patients Have A Much Better Chance Of Living Longer According To A New Norwegian Study
Patients with advanced prostate cancer nowadays are often offered radiation along with hormone therapy.
In a new study, researchers looked at the risk that radiation treatment could lead to other types of cancer.
They compared patients who have only received hormone therapy with patients who have received both radiation and hormone therapy.
We see that the risk of getting a new type of cancer a so-called secondary cancer was somewhat greater among those who had been treated with radiation. The primary increased risk was for bladder cancer, said first author Bjørg Aksnessæther, who is a PhD fellow and senior consultant in the Cancer Department at Ålesund Hospital.
However, the chances of living longer were far better in those who received radiation than in the group that only received hormone therapy.
“Those who only received hormone therapy died to a much greater extent from their prostate cancer,” she said.
What To Do About Changes When You Urinate
Narrator:What to do about changes when you urinate caused by radiation therapy.
Having problems when you urinate? Listen to solutions from other people undergoing radiation therapy. Also, hear advice from Dr. Ross. Then talk with your own doctor or nurse to learn more.
Miguel:Tip number 1: Drink lots of liquids each day.It’s good for your urine to be clear or a pale yellow color. My doctor says that tells you you’re getting enough liquids. Most people find drinking about 8 cups of liquid a day does the trick. Of course, check to make sure that’s the best amount for you, too.
Cara:Tip number 2: Water is wonderful, but you may want more zip in your sip.I like water, but found it was hard to get enough water each day. I was glad to learn that Jell-O and soups also count as liquids. To add some zip to what I drink, I have water with a little lemon and watered-down juices.
Rodney:Tip number 3: Lose the booze.My doctor told me that wine, liquor, or even beer could really bother my bladder. So now I limit these liquids. Some people may need to stay away from wine, liquor, and beer altogether to avoid irritating their bladder.
My doctor also told me to stay away from caffeine in coffee, colas, or teas. They could make my bladder problems worse. I now choose flavored decaf coffees and tasty herbal teas.
Dr. Ross:Hi, I’m Dr. Ross and you just heard 3 great tips to keep bladder problems under control.
- January 23, 2020
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When Do You Have It
You might have radiotherapy:
- as your main treatment instead of surgery
- if your bladder cancer has spread
You have radiotherapy on its own or combined with chemotherapy .
Having radiotherapy instead of surgery means that you don’t need to have surgery to remove your bladder.
But radiotherapy is not usually recommended if you have:
- squamous cell bladder cancer
- carcinoma in situ in much of the bladder lining as well as invasive cancer
- cancer that came back after chemotherapy
- a blockage in the tubes that take urine from the kidneys into the bladder
How Is Radiation Therapy Given
The type of radiation most often used to treat bladder cancer is called external beam radiation therapy. It focuses radiation from a source outside of the body on the cancer.
Before your treatments start, your radiation team will take careful measurements to find the exact angles for aiming the radiation beams and the proper dose of radiation. This planning session, called simulation, usually includes getting imaging tests such as CT or MRI scans. This helps the doctor map where the tumor is in your body. You’ll be asked to empty your bladder before simulation and before each treatment.
The treatment is a lot like getting an x-ray, but the radiation is stronger. Radiation doesn’t hurt. Each treatment lasts only a few minutes, but the setup time getting you into place for treatment usually takes longer. Most often, radiation treatments are given 5 days a week for many weeks.
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Working During Radiation Therapy
Some people are able to work full-time during radiation therapy. Others can work only part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect from the treatment you will have.
You are likely to feel well enough to work when you first start your radiation treatments. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished treatment, it may take just a few weeks for you to feel betteror it could take months.
You may get to a point during your radiation therapy when you feel too sick to work. Talk with your employer to find out if you can go on medical leave. Check that your health insurance will pay for treatment while you are on medical leave.
Possible Risks And Side Effects Of Brachytherapy
Radiation precautions: If you get permanent brachytherapy, the seeds will give off small amounts of radiation for several weeks or months. Even though the radiation doesnt travel far, your doctor may advise you to stay away from pregnant women and small children during this time. If you plan on traveling, you might want to get a doctors note regarding your treatment, as low levels of radiation can sometimes be picked up by detection systems at airports.
There’s also a small risk that some of the seeds might move . You may be asked to strain your urine for the first week or so to catch any seeds that might come out. You may be asked to take other precautions as well, such as wearing a condom during sex. Be sure to follow any instructions your doctor gives you. There have also been reports of the seeds moving through the bloodstream to other parts of the body, such as the lungs. As far as doctors can tell, this is uncommon and doesnt seem to cause any ill effects.
These precautions arent needed after HDR brachytherapy, because the radiation doesnt stay in the body after treatment.
Bowel problems: Brachytherapy can sometimes irritate the rectum and cause a condition called radiation proctitis. Bowel problems such as rectal pain, burning, and/or diarrhea can occur, but serious long-term problems are uncommon.
To learn more, see the Radiation Therapy section of our website.
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How Is Recurrence Tested
After your treatment for bladder cancer has ended, your healthcare providers will monitor you regularly during check-ups for signs and symptoms that your cancer may have recurred.1,2 This might involve tests such as physical examinations, urine tests, blood tests, and/or imaging tests.
Active surveillance is a type of follow-up that involves monitoring a patients condition with specialized tests for signs that the patients condition is getting worse. Usually, treatment is not needed unless the results of the test show that the condition has changed.
It is very important to continue visiting your healthcare provider regularly as scheduled for check-ups, especially if you are receiving active surveillance. Treatment for bladder cancer recurrence tends to be more effective when the recurrence is detected as early as possible.
Travelling To Radiotherapy Appointments
You might have to travel a long way each day for your radiotherapy, depending on where your nearest cancer centre is. This can make you very tired, especially if you have side effects from the treatment.
You can ask the therapy radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.
Car parking can be difficult at hospitals. You can ask the radiotherapy staff if they can give you a hospital parking permit for free parking or advice on discounted parking. They may be able to give you tips on free places to park nearby.
The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. Your radiotherapy doctor would have to agree. This is because it is only for people that would struggle using public transport and have no access to a car.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
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What Happens After Radiation Therapy Treatment Ends
Once treatment ends, you will have follow-up appointments with the radiation oncologist. It’s important to continue your follow-up care, which includes:
Checking on your recovery
Watching for treatment side effects, which may not happen right away
As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.
Important Study Changed Treatment
The study is based on data from a large and important study that was completed in 2009, called the SPCG-7 study.
The study involved 875 Swedish, Norwegian and Danish prostate patients, who were randomly selected for either hormone therapy, or for both radiation and hormone therapy. A randomized study where people are divided by chance means that the groups are more or less similar, which in turn means they can be compared more fairly.
The study showed that men had a better chance of living for a long time if they were treated with both radiation and hormone therapy if they had advanced, local prostate cancer. Advanced, local prostate cancer means that the tumour has grown outside of the prostate capsule, but has not spread to the rest of the body.
The SPCG7 study made radiation with hormone therapy the standard treatment for this patient group, says Aksnessæther.
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Side Effects Of Chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow , the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. When chemo and radiation are given at the same time, side effects tend to be worse. Common side effects of chemo include:
- Nausea and vomiting
- Increased risk of infections
- Easy bleeding or bruising, even after minor cuts or injuries
These side effects usually go away over time after treatment ends. There are often ways to lessen these side effects, some can even be prevented. For instance, drugs can be used to help prevent or reduce nausea and vomiting. Ask your health care team about the side effects your chemo drugs may cause and what can be done to prevent and/or treat them.
Some chemo drugs can cause other, less common side effects. For example, drugs like cisplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to symptoms such as pain, burning or tingling, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy.