Following your recent consultation, your doctor has recommended that your bladder cancer be treated using radiotherapy. This information aims to explain:

• How radiotherapy is used to treat bladder cancer
• The side-effects and their management 
• Your follow up appointments after radiotherapy
   

It is quite normal to feel anxious about your treatment, it may help to talk to someone about it. Please do not be afraid to ask, as we are here to help you.

What is radiotherapy? 
 
Radiotherapy is the use of x-rays to treat your cancer and is given at the Northern Centre for Cancer Treatment (NCCT).

Radiotherapy works by destroying the cancer cells in the treated area, in your case within the bladder.  
 
Radiotherapy is divided into a number of sessions called fractions. It is usually given each weekday for four to six weeks. Using small fractions causes less damage to surrounding normal cells but can still result in some side effects. This information will explain how to manage these.

How is radiotherapy planned? 
 
It is important to plan your radiotherapy specifically for you. This involves two appointments at NCCT before your radiotherapy is actually given.

• The first appointment will be for a planning CT (computerised tomography) scan, which allows the oncologist to plan where the radiotherapy is to be directed.
• The second appointment is called a simulation session, which is a trial run of your treatment to ensure everything is set up correctly. You will not receive radiotherapy during these sessions.

How is radiotherapy given? 
 
Radiotherapy is painless and usually takes 10-15 minutes to deliver. There are private changing rooms within the treatment areas, as some items of clothing will need to be removed. The radiographers will advise you about this and will maintain your privacy at all times. They will take you to the treatment room and help you get into the correct position. You will then be left alone on the treatment couch. You will only be left alone for a few minutes while the treatment takes place and the radiographers will watch you on the TV monitors outside the room. You can attract their attention very easily if you require any assistance.
 
The radiotherapy machine will rotate around your body to give the treatment in different directions. If you wish, you can have music playing to help you relax during your treatment. 

Whilst you are on treatment you will be seen every week in the treatment review clinic by your oncologist, specialist nurse or radiographer. This is to see how you are feeling during the radiotherapy and to discuss any questions or concerns you may have. If you experience any problems in between these review appointments, please inform one of your treatment radiographers.

What happens after my treatment is complete? 
 
Once you have finished your course of radiotherapy you will need to have a cystoscopy (a tube which looks into the bladder) under the care of your consultant urologist. This is usually performed approximately three months after completion of your radiotherapy.

This will enable the urologist to see if the radiotherapy has treated the bladder cancer effectively. You will need to have a cystoscopy at regular intervals, usually every three to six months. 
 
You will also be seen in the outpatient’s department by your oncologist to see how you are after your radiotherapy.  At the clinic you will have the opportunity to ask any questions or discuss any concerns or worries you may have about your cancer and the treatment you have received.

There are a number of side effects that may occur during your radiotherapy. Not everyone experiences them but if you do your specialist team will be able to advise you on how to treat them correctly. Listed below are some of the possible side effects most commonly experienced. These are not immediate and often occur after a few weeks of treatment. The side effects may resolve at varying times following the radiotherapy. If you are experiencing any other problems which are not listed please advise your specialist team who will be happy to discuss them with you. 
 
Tiredness 
 
You may feel tired during your treatment and find that you need to go to bed earlier than you used to or have to take a short nap in the afternoon. This tiredness will resolve itself but it can take up to a couple of months. It may help to remain as active as you can during your radiotherapy but be aware of your limitations.

Changes to your urinary system 
 
During your course of radiotherapy you may experience changes to your urinary symptoms, especially in the last few weeks and on completion of the radiotherapy. If you already have some problems with passing urine, unfortunately these may become worse. You may begin to experience some burning or stinging when you pass urine, sometimes called cystitis. You may feel the need to pass urine more frequently, especially at night. This could also coincide with a strong urgency to pass urine. Whilst having radiotherapy:

• Drink at least eight cups of fluid a day. Don’t be tempted to drink less.
• Avoid smoking and drinking alcohol or drinks containing caffeine – tea, coffee, coca-cola etc. They can all make any urinary problems worse. 
   

Altered bowel habits 
 
Changes in your bowel habits can occur during radiotherapy. If diarrhoea is a problem this is often very mild and changing to a low fibre diet can often help. A dietary advice leaflet is available from your treatment radiographers. Sometimes you may feel that you want to open your bowels frequently but only a small stool or no motion is passed. You may even pass mucus or a small amount of blood, this is called tenemus and you should talk to your specialist nurse or oncologist about this. Again, a low fibre diet can help and medication may be required.
 
Your bowel habits may continue to be disrupted for several weeks following radiotherapy but it should resolve. Please tell your oncologist or specialist nurse if it does not. 
 
Skin reactions 
 
Some people may develop a slight skin reaction (reddening) within the area treated with radiotherapy. This is not very common and the following is advised:
 

• Wash treated skin gently everyday and pat dry. 
• Do not use creams, moisturisers or talcum powders on the area being treated. 
• Keep the treated skin away from direct sunlight or sunlamps. 
   

If a skin reaction occurs please inform your specialist team and they will be able to help you treat this.

This information is a guide to explain your treatment and is not intended to replace the information given to you by your consultant or specialist nurse. It contains a lot of information so if you have further questions regarding your treatment please contact your specialist nurse on the numbers below:
 
Sarah Rushbrooke and Karen Hertwick
Uro Oncology Nurse Practitioners
Northern Centre for Cancer Treatment
Newcastle General Hospital
 
Telephone:  (0191) 256 3585 (answer machine) or
                       (0191) 233 6161 ask for bleep 1774
 
(Monday to Friday 9am – 5pm) 
 
Other useful sources of Information 
 
Miss V Lockey
Information Centre Manager
Northern Centre for Cancer Treatment
Newcastle General Hospital
Newcastle upon Tyne
NE4 6BE

Tel: (0191) 256 3596

The Northern Cancer Network has an information website Northern Cancer Network
 
CancerBACUP. A registered charity providing information and support for cancer patients and their families. CancerBACUP

Telephone: 0808 800 1234