Radiation Therapy for Bladder Cancer
Bladder cancer develops when abnormal cells in the bladder grow uncontrollably. A hollow organ in the pelvic cavity, the bladder stores urine before it is expelled from the body during urination. The exact cause of the cellular mutations that lead to bladder cancer is not always clear. Known risk factors include smoking, exposure to certain chemicals and chronic bladder infections.
Common bladder cancer symptoms include blood in the urine, frequent urination, pain during urination and lower abdominal discomfort. Treatment can vary depending on the type, stage and location of the tumor. Options may include surgery, chemotherapy, immunotherapy and radiation therapy, a non-invasive treatment that uses focused high-energy beams to target and destroy cancer cells.
Radiation therapy is not usually the primary treatment for bladder cancer. More often, it is incorporated into a comprehensive plan that also includes surgery or chemotherapy. However, if surgery is not an option or a patient is unable to receive chemo, radiation therapy might be used on its own.
The main types of radiation therapy for bladder cancer are external beam radiation therapy and internal radiation therapy.
External beam radiation therapy (EBRT) for bladder cancer
EBRT is delivered by a machine (linear accelerated) located outside the patient’s body. The linear accelerator generates powerful energy beams and directs them precisely at the tumor site to minimize any exposure to the surrounding healthy tissues. Often used in combination with chemotherapy for enhanced treatment effectiveness, EBRT is typically administered on an outpatient basis, with sessions scheduled five days a week over several weeks.
What are the risks and possible complications of external beam radiation therapy for bladder cancer?
EBRT for bladder cancer carries several risks and potential complications, which can vary depending on the specifics of the treatment plan and the patient’s overall health. Common side effects include fatigue, skin irritation in the treated area and bladder inflammation, which can lead to frequent urination, painful urination and bloody urine. Some patients also experience bowel issues, such as general discomfort and diarrhea, especially if the surrounding tissues are affected by the radiation.
Possible long-term complications of EBRT for bladder cancer include urinary incontinence, bladder scarring (fibrosis) and changes in sexual function. Though rare, there is also a risk of secondary cancers forming in the irradiated area. With close monitoring by the medical team, the side effects can be managed and the risk of complications can be minimized.
What to expect during recovery from external beam radiation therapy for bladder cancer
After EBRT for bladder cancer, the patient can expect any treatment side effects to gradually improve and ultimately resolve within a few weeks or months as their body heals from the effects of the radiation. While most patients can return to their normal activities, the pace of recovery can vary. Regular follow-up appointments will be important to monitor progress, manage any ongoing symptoms and ensure the cancer treatment is effective.
How effective is external beam radiation therapy for bladder cancer?
The effectiveness of EBRT for bladder cancer can vary depending on several factors, including the stage of the tumor and the specifics of the treatment plan; e.g., whether radiation therapy was used alone or in combination with other therapies. EBRT can be effective for early-stage, localized bladder cancer, particularly when used as part of a bladder-sparing treatment approach for a patient who cannot undergo surgery or after surgery to eliminate any remaining cancer cells.
For patients with muscle-invasive bladder cancer, EBRT can be an alternative to bladder removal (radical cystectomy), potentially preserving bladder function while controlling tumor growth. However, radiation therapy is not a curative treatment for widespread cancer.
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Internal radiation therapy (brachytherapy) for bladder cancer
Brachytherapy for bladder cancer involves placing a small radioactive source, such as seeds, pellets or wires, directly into or near a tumor inside the bladder. This approach allows for a high dose of radiation to be delivered directly to the cancer cells while minimizing any exposure to the surrounding healthy tissues. Brachytherapy is typically used for localized bladder tumors that are confined to the bladder lining, especially in cases where surgery is not an option.
During the procedure, a radiation oncologist will insert a catheter or applicator into the bladder and then place the radioactive source near the tumor. The radiation will target the cancer cells over a specific period, usually a few minutes to hours, which can vary depending on the treatment plan. Brachytherapy can be delivered in a single session or multiple fractions.
What are the risks and possible complications of internal radiation therapy for bladder cancer?
Brachytherapy for bladder cancer carries both short- and long-term risks. Temporary side effects may include bladder irritation, which can cause urinary urgency, urinary frequency, painful urination and blood in the urine. Urinary tract infections (UTIs) may also develop because germs can enter the urinary tract through the catheter or applicator.
Long-term risks of brachytherapy for bladder cancer include bladder fibrosis, which may lead to complications such as reduced bladder capacity, difficulty emptying the bladder or urinary incontinence. While rare, there is also a risk of damage to the surrounding tissues, such as the urethra and rectum.
Additionally, while the risk is minimal, there is a slight possibility of developing a secondary cancer in the treated area, even many years after treatment is complete. Close monitoring during and after brachytherapy is essential to manage these risks and complications effectively.
What to expect during recovery from internal radiation therapy for bladder cancer
During recovery from brachytherapy, the patient may experience increased urinary frequency, mild burning during urination and occasional blood in the urine. Some patients also notice mild fatigue or temporary changes in bowel habits, such as loose stools. Usually, these symptoms are mild and resolve within a few weeks as the body adjusts to the effects of the radiation. The patient might also have slight discomfort from the catheter or applicator used during the procedure, though it should subside shortly after the device is removed. Staying well hydrated, consuming a balanced diet and taking prescribed medications as directed can help manage any side effects and support recovery.
In the weeks following brachytherapy, the patient should be watchful for signs of infection, such as fever and increased pain, and inform their physician if any concerns arise. Follow-up appointments will be crucial to assess the effectiveness of the treatment and monitor for long-term complications, such as bladder scarring and changes in urinary function.
How effective is internal radiation therapy for bladder cancer?
EBRT is used more frequently than brachytherapy for bladder cancer. However, internal radiation therapy can be effective in certain cases, particularly those involving localized tumors that are confined to the bladder lining. Brachytherapy delivers a high dose of radiation directly to the tumor, which can lead to excellent tumor control while minimizing any damage to the surrounding healthy tissues. This targeted approach is often considered in cases where surgery is not an option or in combination with EBRT for heightened treatment effectiveness. The overall success of treatment can vary depending on factors such as the stage of the cancer, the health of the patient and how well the radiation targets the tumor.
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How do I know if radiation therapy is right for me?
When evaluating radiation therapy and other treatment options for bladder cancer, key factors to consider include:
- Tumor stage and location – Radiation therapy is often used for localized bladder cancer or as part of a bladder-sparing treatment plan for muscle-invasive cancer. It is also commonly used after surgery to target any remaining cancer cells. If the cancer has spread beyond the bladder (metastasized), systemic treatment may be more appropriate.
- Health and treatment preferences – If surgery is not an option due to other health conditions or personal preferences, radiation therapy may be considered as an alternative to a radical cystectomy. It may also be an option for a patient who wants to avoid surgery and preserve bladder function.
- Combined treatment approach – Radiation therapy is often used in combination with chemotherapy for enhanced effectiveness, especially in patients with muscle-invasive bladder cancer and those who are not candidates for surgery.
- Risks and complications – An oncologist can explain the possible side effects of radiation therapy, such as fatigue, bladder irritation and scarring. They will also discuss how the risks align with the patient’s health status and treatment goals.
- Response to previous treatments – If the patient has already undergone surgery, chemotherapy or other treatments and the cancer is not fully controlled, radiation therapy might be considered as a follow-up option to target residual cancer cells.
Benefit from world-class care at Moffitt Cancer Center
The multispecialty team in Moffitt’s high-volume Urologic Oncology Program includes renowned experts in all facets of bladder cancer treatment, and we are continually developing new radiation delivery techniques to help each patient achieve the best possible outcome and quality of life. Moffitt is also an American College of Radiology-accredited center, a designation that recognizes the expertise of our team as well as the high quality of our equipment and facilities.
Moffitt is honored to be a National Cancer Institute-designated Comprehensive Cancer Center, which is a testament to our extensive research efforts and robust portfolio of clinical trials. We are proud to offer our patients unique opportunities to benefit from novel cancer treatments that are not yet available elsewhere.
If you would like to learn more about radiation therapy for bladder cancer, you can request an appointment with a specialist in our Urologic Oncology Program by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.