Monday, January 30, 2023

Side Effects Of Chemo And Radiation For Bladder Cancer

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Bcg Or Intravesical Chemotherapy

Radiation Treatment: Managing Your Side Effects

BCG produces generally better results but has more serious treatment effects. Intravesical chemotherapy has fewerserious treatment effects but may not be as effective as BCG. If you have a high-risk tumour you would usually receive BCG, if anintermediate risk tumour you would often receive intravesical chemotherapy.

When you are given a single dose of intravesical chemotherapy during youroperation, it is because when a tumour is removed from the bladder there is aworry that some of the cancer cells can break off and stick to the bladder wallwhere they can grow and form new tumours. It is now the recommended standard practice to put a singledose of intravesical chemotherapy into the bladder at the end of the surgerywhich destroys any cancer cells floating about and can reduce the chances of gettingfurther recurrences. BCG is not given at this time because of the risk ofabsorption of the BCG through the operation site.

Cystectomy isrecommended for non-invasive tumours or carcinoma-in-situ that are resistant orrefractory to intravesical treatment. While offering long-term control,removing the bladder has major implications and potential complications, andwould not be undertaken unless the risks of progression are high.

Radiotherapy and systemic chemotherapy arenot effective treatments for non-muscle invasive bladder cancer.

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Low Levels Of Vitamin B12

You might have low vitamin B12 after radiotherapy to the pelvis . This is called a vitamin B12 deficiency.

Radiotherapy can stop your digestive system from 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 weakness, diarrhoea, numbness and tingling.

Its important that you go to your doctor if youre experiencing these symptoms so that they can help you.

Changes To Your Sex Life

You can have some changes that can affect your sex life. These changes may continue some time after treatment.

Men can experience a lower sex drive, difficulty in getting an erection or problems with ejaculation.

Women may have dryness and shrinkage of the vagina, making sex painful. Some women also experience an early menopause.

Both men and women might lose their fertility.

  • Cancer, Intimacy and Sexuality: A Practical ApproachY Reisman and others

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Sex After Intravesical Chemotherapy

Men should use a condom during sex for the first 48 hours after chemotherapy. If you are a woman having chemotherapy, your partner should use a condom during this time. This protects your partner from any of the drug that may be present in semen or vaginal fluid. Your doctor or specialist nurse can give you more information about this.

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If Youre Having Radiation Therapy To The Pelvis

Radiotherapy and chemotherapy for bladder cancer

Radiation therapy to the pelvis can cause side effects such as:

  • Bladder problems
  • Fertility problems
  • Changes in your sex life

You might also have some of the same problems people get from radiation to the abdomen, such as nausea, vomiting, diarrhea, or constipation.

Bladder problems

Radiation to the pelvis can cause problems with urination, including:

  • Pain or burning sensations
  • Blood in the urine
  • An urge to urinate often

Most of these problems get better over time, but radiation therapy can cause longer-term side effects as well:

  • Radiation cystitis. If the radiation damages the lining of the bladder, radiation cystitis can be a long-term problem that causes blood in the urine or pain when passing urine.
  • Urinary incontinence. Radiation treatments for certain cancers, such as prostate and bladder cancer, may make you unable to control your urine or have leakage or dribbling. There are different types and degrees of incontinence, but it can be treated. Even if incontinence cant be corrected completely, it can still be helped. See Bladder and Bowel Incontinence to learn more. This side effect is most often a problem for men being treated for prostate cancer, but some of the information might also be helpful for women dealing with treatment-related incontinence.

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Radiation Therapy Side Effects

Radiation not only kills or slows the growth of cancer cells, it can also affect nearby healthy cells. Damage to healthy cells can cause side effects.

Many people who get radiation therapy have fatigue. Fatigue is feeling exhausted and worn out. It can happen all at once or come on slowly. People feel fatigue in different ways and you may feel more or less fatigue than someone else who is getting the same amount of radiation therapy to the same part of the body. See Fatigue and Cancer Treatment to learn more.

Other radiation therapy side effects you may have depend on the part of the body that is treated. To see which side effects you might expect, find the part of your body being treated in the following chart. Many of the side effects in the list link to more information in the Side Effects section. Discuss this chart with your doctor or nurse. Ask them about the side effects that you might expect.

Viii Contraindications To Administration:

Patients who are pregnant or lactating, have liver disease, a history of active or prior tuberculosis should not receive chemotherapeutic drugs.

  • Intravesical BCG is contraindicated the following conditions:
  • Within 7 to 14 days of bladder or prostatic surgery, including biopsy
  • Within 7 to 14 days following traumatic catheterization
  • Traumatic catheterization or gross hematuria day of treatment
  • Immunosuppressed patients with congenital or acquired immune deficiency, whether due to concurrent disease , cancer therapy or immunosuppressive therapy .
  • If these conditions are present, but treatment is still deemed necessary, informed consent should be discussed by prescribing provider and documented in patients record.
  • Symptomatic urinary tract infection
  • In the presence of febrile illness
  • Patients on treatment with certain antibiotics that may interfere with effectiveness of BCG.
  • Discuss with prescribing or collaborating provider before administration.
  • Fluoroquinolones should be used with caution as they may alter the therapeutic effects of BCG.
  • Any previous allergies or adverse reactions to BCG.
  • Intravesical chemotherapy is contraindicated the following conditions:
  • Any previous allergy or adverse reactions to the chemotherapeutic agent
  • bladder perforation
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    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.

    Physical Emotional And Social Effects Of Cancer

    What are the side effects of radiation therapy?

    Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

    Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after an advanced cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

    Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

    Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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    Managing Bladder Cancer Treatment Side Effects

    There are often solutions to bladder cancer treatment side effects. Ask your doctor beforehand what you can expect from your specific treatment. Find out how you can avoid side effects and how your doctor plans to deal with them if they occur. Many side effects have specific solutions to relieve your symptoms. With surgery, the doctorâs experience with the procedure often plays a role in its success.

    Can Bladder Cancer Impact Sexual Function

    It is not uncommon for bladder cancer and its treatments to cause sexual dysfunction in patients.1 The type of effects that a patient experiences depends in large part on the type of treatment for bladder cancer that the patient receives. Patients may experience a decrease in their levels of sexual desire, for both physical and/or emotional reasons. Men may experience issues with getting and maintaining an erection, for example, while women may experience issues with vaginal dryness, irritation or discomfort that can make having sex uncomfortable. However, there are many options for managing and reducing the sexual effects of bladder cancer and many patients are able to regain the ability to have and enjoy sexual activities again.

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    What Are The Treatment Options For Bladder Cancer

    There are four types of treatment for patients with bladder cancer. These include:

    • Surgery

    Sometimes, combinations of these treatments will be used.

    Surgical options

    Surgery is a common treatment option for bladder cancer. The type of surgery chosen will depend on the stage of the cancer.

    • Transurethral resection of the bladder is used most often for early stage disease . It is done under general or spinal anesthesia. In this procedure, a special telescope called a resectoscope is inserted through the urethra into the bladder. The tumor is then trimmed away with the resectoscope, using a wire loop, and the raw surface of the bladder is then fulgurated .
    • Partial cystectomy is the removal of a section of the bladder. At times, it is used for a single tumor that invades the bladder wall in only one region of the bladder. This type of surgery retains most of the bladder. Chemotherapy or radiation therapy is often used in combination. Only a minority of patients will qualify for this bladder-sparing procedure.
    • Radical cystectomy is complete removal of the bladder. It is used for more extensive cancers and those that have spread beyond the bladder .

    This surgery is often done using a robot, which removes the bladder and any other surrounding organs. In men, this is the prostate and seminal vesicles. In women, the ovaries, uterus and a portion of the vagina may be removed along with the bladder.

    Chemotherapy

    • Methotrexate

    Intravesical therapy

    Radiation therapy

    What Else Can I Do

    Top 5 Side Effects Of Chemotherapy Cancer Treatment

    Drinking plenty of fluids may also help to âflushâ the bladder and prevent cystitis.

    References

  • Turkeri LN, Lum LG, Uberti JP, Abella E, et al. Prevention of hemorrhagic cystitis following allogeneic bone marrow transplant preparative regimens with cyclophosphamide and busulfan: role of continuous bladder irrigation. J Urol. 1995 153:637-40.
  • Drake MJ, Nixon PM, Crew JP. Drug-induced bladder and urinary disorders. Incidence, prevention and management. Drug Saf. 1998 19:45-55.
  • Khojasteh NH, Zakerinia M, Ramzi M, Haghshenas M. A new regimen of MESNA effectively prevents cyclophosphamide-induced hemorrhagic cystitis in bone marrow transplant recipients. Transplant Proc. 2000 May 32: 596.
  • Cohen MH, Dagher R, Griebel DJ, Ibrahim A, et al. U.S. Food and Drug Administration drug approval summaries: imatinib mesylate, mesna tablets, and zoledronic acid. Oncologist. 2002 7: 393-400.
  • Ballen KK, Becker P, Levebvre K, Emmons R, et al. Safety and cost of hyperhydration for the prevention of hemorrhagic cystitis in bone marrow transplant recipients. Oncology. 1999 Nov 57: 287-92.
  • https://pubmed.ncbi.nlm.nih.gov/7707439/
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    Weaker Bones And Crack In Bones

    Having pelvic radiotherapy can cause your bones to become weaker, this can make you more prone to them breaking . This usually might develop after youve finished your radiotherapy treatment.

    Your doctor might give you a medicine to strengthen your bones called bisphosphonates. These drugs can help to control pain and reduce the risk of fractures. If they think you have fractured your bone you may have an x-ray, CT scan or MRI scan to check this.

    Let your team know of any pain you may have.

    Radiotherapy Outcomes For Specific Bladder Symptoms

    Haematuria affects nearly a third of patients with MIBC and can cause pain and symptomatic anaemia . Frank haematuria with clot formation can result in painful retention necessitating catheterisation. In those patients unfit for surgical intervention definitive management options may include embolization or radiotherapy. Radiotherapy is effective for haemostasis in multiple malignancies. The mechanism by which it achieves haemostasis is poorly understood but may be due to destruction of tissue microvasculature and/or stimulation of platelet activation .

    The BA09 trial provides the best evidence of the efficacy of radiotherapy for haemostasis in bladder cancer. At baseline 167 of 494 patients had significant haematuria, with 20% suffering from continuous haematuria or haematuria with visible clots. Immediately following the completion of the radiotherapy regime over half of these patients experienced improvement in their haematuria with worsening symptoms were seen in less than 10%. The rapid onset of haematuria relief has been confirmed by several other retrospective studies . In the BA09 study the benefit continued to accrue and at 3 months post treatment, in those patients still alive, 88% had resolution of their haematuria which was prolonged with a median time to deterioration of symptoms of 9 months.

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    Possible Side Effects Of Mitomycin Given Into The Bladder

    • Mitomycin can cause skin irritation if it comes into contact with the skin. Washing the area with soap and water after urinating can reduce this risk.
    • Some patients will develop a bladder infection after this procedure. If you experience an urgency to urinate, burning or pain with urination, blood in the urine or fever, notify your healthcare team right away.
    • Intravesicular chemotherapy may cause burning with urination, cramps and diarrhea.
    • In some rare cases, mitomycin can cause a decrease in your blood counts. This can include white blood cells , platelets and red blood cells. This is more likely to occur when the medication is given after surgery and there is injury in the bladder , which can allow the medication to be absorbed into the blood stream. However, it can occur with any instillation.

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    Side Effects Of Radiation Therapy

    Adjuvant Chemotherapy Benefit Observed in Patients With Advanced Bladder Cancer

    Radiation therapy for bladder cancer can cause temporary side effects, including needing to urinate more often and more urgently, burning when you pass urine, fatigue, loss of appetite, diarrhoea and soreness around the anus. Symptoms tend to build up during treatment and usually start improving over a few weeks after treatment ends.

    Less commonly, radiation therapy may permanently affect the bowel or bladder. Bowel motions may be more frequent and looser, and damage to the bladder lining can cause blood in the urine.

    Radiation therapy for males may cause poor erections and make ejaculation uncomfortable for some months after treatment. For females, radiation therapy can cause the vagina to become drier, narrower and shorter. See some ways to manage these changes.

    For more on this, see our general section on Radiation therapy.

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    What Bladder Problems May Occur As Side Effects Of Cancer Treatment

    Irritation of the lining of the bladder is called cystitis. This condition is commonly caused by a urinary tract infection, where bacteria have infected your bladder. However, it is also a side effect of some cancer treatments. Cancer patients in particular are at increased risk of developing a more severe form of cystitis called hemorrhagic cystitis. This condition may occur during treatment, immediately following treatment or months after treatment. Hemorrhagic cystitis can be a very serious condition leading to significant bleeding and/or life-threatening infection.

    Before You Start Chemotherapy

    You need to have blood tests to make sure its safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

    Before each treatment you need to stop drinking fluids. This stops the urine from diluting the drug in your bladder and will help you hold the urine more easily. Your hospital will tell you when to stop drinking.

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    Transurethral Resection Of Bladder Tumor

    When youre having bladder preserving therapy, you may need a repeat TURBT to remove as much of the bladder tumour as possible before starting chemotherapy and radiation.

    TURBTs may be repeated as treatment progresses to remove any additional tumours that have grown. These tumours are identified using cystoscopies , which you likely have also had previously.

    If Youre Getting Radiation Therapy To The Head Or Neck

    Bladder cancer

    People who get radiation to the head and neck might have side effects such as:

    • Soreness in the mouth or throat
    • Dry mouth
    • Jaw stiffness

    How to care for your mouth during treatment

    If you get radiation therapy to the head or neck, you need to take good care of your teeth, gums, mouth, and throat. Here are some tips that may help you manage mouth problems:

    • Avoid spicy and rough foods, such as raw vegetables, dry crackers, and nuts.
    • Dont eat or drink very hot or very cold foods or beverages.
    • Dont smoke, chew tobacco, or drink alcohol these can make mouth sores worse.
    • Stay away from sugary snacks.
    • Ask your cancer care team to recommend a good mouthwash. The alcohol in some mouthwashes can dry and irritate mouth tissues.
    • Rinse your mouth with warm salt and soda water every 1 to 2 hours as needed.
    • Sip cool drinks often throughout the day.
    • Eat sugar-free candy or chew gum to help keep your mouth moist.
    • Moisten food with gravies and sauces to make it easier to eat.
    • Ask your cancer care team about medicines to help treat mouth sores and control pain while eating.

    If these measures are not enough, ask your cancer care team for advice. Mouth dryness may be a problem even after treatment is over. If so, talk to your team about what you can do.

    How to care for your teeth during treatment

    Radiation treatment to your head and neck can increase your chances of getting cavities. This is especially true if you have dry mouth as a result of treatment.

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