Side Effects Of Radiation For Bladder Cancer

How Long Do Side Effects Last

Remember that the type of radiation side effects you might have depends on the prescribed dose and schedule. Most side effects go away within a few months of ending treatment. Some side effects may continue after treatment ends because it takes time for the healthy cells to recover from radiation.

Side effects might limit your ability to do some things. What you can do will depend on how you feel. Some patients are able to go to work or enjoy leisure activities while they get radiation therapy. Others find they need more rest than usual and cant do as much. If you have side effects that are bothersome and affecting your daily activities or health, the doctor may stop your treatments for a while, change the schedule, or change the type of treatment youre getting. Tell your cancer care team about any side affects you notice so they can help you with them.

Risk Factor: Chemical Exposure

Research suggests that certain jobs may increase your risk for bladder cancer. Metal workers, mechanics, and hairdressers are among those who may be exposed to cancer-causing chemicals. If you work with dyes, or in the making of rubber, textiles, leather, or paints, be sure to follow safety procedures to reduce contact with dangerous chemicals. Smoking further increases risk from chemical exposure.

Anyone can get bladder cancer, but these factors put you at greater risk:

• Gender: Men are three times more likely to get bladder cancer.
• Age: Nine out of 10 cases occur over age 55.
• Race: Whites have twice the risk of African-Americans.

Other factors at play include a family history of bladder cancer, previous cancer treatment, certain birth defects of the bladder, and chronic bladder irritation.

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Who Can Have This Treatment

BCG is appropriate for noninvasive and minimally invasive bladder cancers. It usually follows a procedure called transurethral resection of bladder tumor . Its intended to help prevent recurrence.

This treatment only affects cells inside the bladder. Its not useful for later stage bladder cancer that has spread into or beyond the bladder lining, or to other tissues and organs.

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Risk Factors For Bladder Cancer

There are some things that can make you more likely to develop bladder cancer. These are called risk factors and they include:

• smoking chemicals in cigarettes can cause bladder cancer, so if you smoke, your risk is up to three times that of a non-smoker
• age most people with bladder cancer are over 60 years of age
• family history a first degree relative with bladder cancer increases risk up to nearly 2 times higher than the general population
• chemicals being in contact with certain chemicals for a long period of time, like aromatic amines, benzene products and aniline dyes, which have been linked to bladder cancer
• frequent infections of the bladder over a long period of time
• some types of radiation therapy around the pelvis, and the chemotherapy drug cyclophosphamide.

Having these risk factors doesnt mean you will develop bladder cancer. Often there is no clear reason for getting bladder cancer. If you are worried about your risk factors, ask your doctor for advice.

Radiotherapy With A Radiosensitiser

Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.

A medicine called a radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This medicine affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.

As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:

• difficulty passing urine

Most of these side effects should pass a few weeks after your treatment finishes, although theres a small chance theyll be permanent.

Having radiotherapy directed at your pelvis usually means youll be infertile .

After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.

You may also be offered CT scans of your chest, abdomen and pelvis after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.

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The Role Of Palliative Radiotherapy In Bladder Cancer: A Narrative Review

Sophie E. M. Raby1, Peter Hoskin2,3, Ananya Choudhury1,2

1Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre , UK 2Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre , , UK

Contributions: Conception and design: None Administrative support: None Provision of study materials or patients: None Collection and assembly of data: None Data analysis and interpretation: None Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Bladder cancer radiotherapy dysuria frequency haematuria

Submitted Jul 01, 2020. Accepted for publication Oct 05, 2020.

doi: 10.21037/apm-20-1347

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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Coping With The Side Effects Of Radiation Therapy

Everyone’s experience with radiation therapy is different. Side effects vary from person to person, even when given the same type of treatment. Before your treatment, ask your health care team which physical side effects are possible and what to watch for. You may also experience emotional side effects. Seeking out mental health support to help with anxiety and stress is important.

Ask your health care team about ways to take care of yourself during the treatment period, including getting enough rest, eating well, and staying hydrated. Ask whether there are any restrictions on your regular exercise schedule or other physical activities. If so, talk with them about another way to get regular exercise.

Continue to talk to your health care team throughout your treatment. Tell them when side effects first appear, worsen, or continue despite treatment. That will help your health care team provide ways to help you feel better during and after treatment.

Transurethral Resection Of The Bladder Cancer Tumor

This is when the tumor is removed from the urinary tract through the urethra using an electrical force. Transurethral resection is an endoscopic or scope procedure that does not involve making an incision in the body.

Drug therapy after TUR is commonly prescribed for patients with large, multiple or high-grade tumors.

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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.

How Fertility Might Be Affected

For women: Talk to your cancer care team about how radiation might affect your fertility . Its best to do this before starting treatment so you are aware of possible risks to your fertility.

Depending on the radiation dose, women getting radiation therapy in the pelvic area sometimes stop having menstrual periods and have other symptoms of menopause. Report these symptoms to your cancer care and ask them how to relieve these side effects.Sometimes menstrual periods will return when radiation therapy is over, but sometimes they do not.

See Fertility and Women With Cancer to learn more.

For men: Radiation therapy to an area that includes the testicles can reduce both the number of sperm and their ability to function. If you want to father a child in the future and are concerned about reduced fertility, talk to your cancer care team before starting treatment. One option may be to bank your sperm ahead of time.

See Fertility and Men With Cancer to learn more.

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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.

Which Cancer Treatments Cause Cystitis

Cystitis in cancer patients is often caused by treatment with the chemotherapy drugs cyclophosphamide and ifosfamide, administration of treatments directly into the bladder, or radiation therapy to the pelvic region.

Cyclophosphamide and ifosfamide: Cystitis is commonly caused by treatment with the chemotherapy drugs cyclophosphamide and ifosfamide. Drugs are broken down in the body to substances called metabolites. Acrolein is a metabolite produced when cyclophosphamide and ifosfamide are broken down. This metabolite is cleared from the body in the urine and irritates the lining of the bladder as it is being passed.

High-dose chemotherapy prior to stem cell transplant: High-dose cyclophosphamide and/or busulfan is often administered in conjunction with a stem cell transplant. This treatment is associated with significant, and sometimes life-threatening hemorrhagic cystitis.1

Delivery of treatment directly into the bladder: A treatment for superficial bladder cancer is to deliver chemotherapy directly into the bladder, called intravesical installation. This is done by passing the chemotherapy through a catheter in the urethra, the tube that carries urine from the bladder. This approach delivers the chemotherapy drugs at full strength directly to the cancer, but may also irritate the lining of the bladder. The drugs commonly used for this approach are mitomycin-C , thiotepa or doxorubicin .

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When To See A Doctor

There are a few side effects that can be especially dangerous, so make sure to talk to your doctor if you notice that you:

• Have a severe skin rash
• Are wheezing or having difficulty breathing
• Are finding swallowing to be difficult
• Have a high fever that isnt lowered with Tylenol or other over-the-counter fever reducers

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What Are The Side Effects Of Radiation Therapy

The side effects of radiation therapy for bladder cancer can be divided into the following.

Side effects during/soon after treatment

General tiredness is not uncommon during radiation therapy and may be worse if you are having chemotherapy at the same time. This will improve a few weeks to a few months after the treatment is over.

Local most people will notice the need to pass urine more frequently and stinging or burning when passing urine in the second half of their treatment. With the extra fluid given along with chemotherapy, this may be worse on some days compared to others through the treatment course.

Treatment can be delivered between 2 to 7 weeks depending on the goal of treatment and other factors. Keeping the urine dilute and using urine alkylising agents, e.g. Ural, can help reduce stinging and burning when passing urine.

The bowels may also be affected temporarily with increased gas and/or diarrhoea or mild change in bowel habit. This is because some portions of bowel may be within the field receiving radiation. Again, these early side effects will almost certainly settle back to normal a few weeks after treatment is completed.

Keeping well hydrated and using medication to slow bowel activity can help this. Sometimes diet might need to be modified.

Side effects well after treatment

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Reddening Or Darkening Of Your Skin

Your skin might go red or darker in the treatment area. You might also get slight redness or darkening on the other side of your body. This is where the radiotherapy beams leave the body. It’s not likely to be that noticeable for bladder cancer but do tell your radiographer if you notice any skin changes.

The red or darker areas can feel sore. Using a cream helps keep the skin hydrated and soothe it. The soreness usually goes away within 2 to 4 weeks of ending the treatment. But your skin might always be slightly darker in that area.

Your radiographers will tell you which cream you should use.

What Is A Late Effect

A late effect is a side effect that is caused by treatment but happens months to years after the cancer treatment has finished. Some side effects that you develop during treatment can last for months to years after treatment is completed . These are often called long-term side effects.

Late effects can be health issues or psychological, emotional, and practical challenges.

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Simultaneous Detection Of Antigen

PBMCs were labeled with CFSE and expanded with optimal dose of live BCG in 1 ml of cR-10 containing 10% heat-inactivated human AB serum , or resting in medium alone for 7 days at 37°C with 5% CO2. On day 7, cell suspensions were mixed 1:500 with Cell Activation Cocktail for 5 h. Cells were then processed for total live cell count and staining with fluorochrome-conjugated anti-human CD3 mAb , CD4 mAb , CD8 mAb and γδ TCR mAb , followed by fixation and permeabilization with Cytofix/Cytoperm buffer prior to intracellular staining with fluorochrome-conjugated anti-human IFN-γ mAb . Data were acquired with an LSR II cytometer and analyzed using FACS Diva software . Absolute numbers of proliferated functional CD4+, CD8+, and γδ T cells were calculated by multiplying total viable cells recovered after 7-day culture by percentages of proliferated functional T cell subsets. Fold changes of response by 3 and 6 months were calculated over baseline except in two cases baseline were substituted with week 1 due to blood/PBMCs availability.

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When Is Bladder Cancer Radiation Therapy Used

Radiation therapy for bladder cancer is used for various reasons. A few of them are listed below-

• It is used as one of the treatment parts for a few early-stage bladder cancers. RT is used after surgery which fails to remove the entire bladder like TURBT.
• RT is considered a primary treatment method for individuals with earlier-stage cancers. Especially who cant go through treatment methods such as chemotherapy or surgery.
• Also advised for people who want to avoid cystectomy. It is a surgery involving the removal of the bladder.
• Oncologists use RT for treating people who have advanced bladder cancer
• RT is used to treat and prevent symptoms of advanced bladder cancer.

Bladder cancer radiation therapy is often accompanied by chemotherapy. Chemotherapy aid in enhancing radiation effectiveness. The whole process is generally called chemoradiation.

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Why Does Radiation Therapy Cause Side Effects

In this type of treatment, high doses of radiation therapy are used to destroy cancer cells. Side effects come from damage to healthy cells and tissues near the treatment area.

There have been major research advances in radiation therapy over recent years that have made it more precise. This has reduced this treatment’s side effects compared to radiation therapy techniques used in the past.

Some people experience few or no side effects from radiation therapy. Other people experience more severe side effects. Reactions to radiation therapy often start during the second or third week of treatment. Or, they may last for several weeks after the final treatment. Some side effects may be long term. Talk with your treatment team about what you can expect.

Treatment Areas And Possible Side Effects

Healthy cells that are damaged during radiation treatment usually recover within a few months after treatment is over. But sometimes people may have side effects that do not improve. Other side effects may show up months or years after radiation therapy is over. These are called late effects. Whether you might have late effects, and what they might be, depends on the part of your body that was treated, other cancer treatments you’ve had, genetics, and other factors, such as smoking.Ask your doctor or nurse which late effects you should watch for. See the section on Late Effects to learn more.

• Reviewed:January 11, 2022

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