Radiotherapy to the bladder

It will be given to you in addition to the information you will receive from your Clinical Oncologist (who is a specialist doctor in cancer treatment). Their team will be caring for you during your treatment. This team will include radiographers and clinical nurse specialists but may also include social workers, physiotherapists, occupational therapists and dietitians.
The leaflet describes radiotherapy planning and treatment. It also explains the side-effects which you may experience during and after treatment.
Each person’s treatment will vary, so the information given is a general guide. The healthcare team looking after you will explain your treatment and the side-effects in detail.
If you have any questions after reading this leaflet, please speak to the team looking after you or ring the numbers at the end of leaflet. Staff will make every effort to meet your individual needs or will direct you to the person who can help.

What is radiotherapy?

Radiotherapy is the use of high energy X-rays and other types of radiation to treat cancer. Radiotherapy causes damage to the cancer cells in the treated area. Although normal cells are also affected, they can repair themselves and are able to recover.

Radiotherapy is a local treatment. This means it only affects the part of the body that is treated.

When you are having your radiotherapy you do not feel anything and it does not make you radioactive. You may hear a buzzing noise when the machine is switched on.
It is perfectly safe for you to be around others, including children and anyone who may be pregnant, throughout your treatment.

You will have your radiotherapy on a treatment machine called a linear accelerator, as shown here in the photograph. You will see your radiographers at each treatment session, and they will be happy to answer any questions you may have.

How often is it given?

Radiotherapy is usually given over one day to seven weeks. This is a total of between 1-35 treatment days. Treatment is usually given daily, Monday to Friday however your treatment may start on any day of the week. Sometimes it is given once a week, for several weeks.

Whenever possible you will be treated at the time of day that suits you, but this cannot always be arranged or guaranteed.

There may be occasions when you may have a longer stay in the department or be asked to attend at a different time, for example to see your oncologist.

You may need to be treated on a weekend during the day due to a bank holiday and we will let you know if this is the case. Your radiographer will be able to explain the details of your individual radiotherapy appointments. Your treatment will usually be given as an outpatient.

Visiting us before your treatment

If you would like to visit the radiotherapy department before starting treatment, please call 0113 206 7603.

This visit can be very useful as you can find out more information about radiotherapy and ask questions.

Who will I meet?

Therapeutic radiographers

Radiotherapy is given by therapeutic radiographers of all genders, who are highly trained in the accurate planning and delivery of radiotherapy treatment.

You will see your radiographers at each treatment session and they will be happy to answer any questions you may have.

Student radiographers

The radiotherapy department is a training centre for therapeutic radiographers. They are supervised at all times. If you do not wish students to be present, please speak to a member of staff. This will not affect your treatment or care.

Others involved in your care

You may meet other staff whilst you are coming for radiotherapy. Everyone you meet will introduce themselves, tell you their job title and explain the role they have in your care.

Important advice before your treatment

Pregnancy

It is very important that people who can become pregnant, are not pregnant at the start of a course of radiotherapy. Also, do not become pregnant during a course of radiotherapy because it can have an effect on the unborn child.

Use an effective form of contraception, for example condoms, coil, depo injection or contraceptive pill.

For more information see the ‘Contraception and pregnancy during cancer treatment’ leaflet.

Please do not hesitate to ask your doctor or nurse if you have any questions or concerns about these issues.

Planning your treatment

Your first appointment for radiotherapy will be a planning appointment. This will be used to gather all the information we need to accurately plan your treatment. We will contact you by phone, with an appointment for your radiotherapy planning session. Directions to the hospital and transport arrangements will be discussed with you at this point.
Some tests and scans may be needed to help plan your treatment. We will explain which of these you will need when your appointment is made.

You may see your clinical oncologist (or a member of their team) at this appointment. This is an ideal opportunity for you to ask questions.

If you have not previously consented to your treatment you will be asked to sign a consent form.

What to bring with you:

• A list of all questions you may have;
• An up-to-date list of all the medications you are taking (including inhalers, sprays, vitamins or herbal products);
• Any medication that you may need during your visit;
• Something to eat and drink and something to occupy yourself with, as this first visit can be quite lengthy (up to two hours).

Your planning scan

In order to plan your treatment you will have a planning CT scan. This is done on a machine called a CT Scanner, shown here in the photograph. It allows the images from the scan to be sent to the radiotherapy computer planning system.There will be several members of staff present at your scan. These will include therapeutic radiographers, and possibly a dosimetrist (the person who will produce the computer plan for your treatment).

You will need to undress and wear a gown for your planning scan. The radiographers will explain this to you. You will be asked to lie flat as shown here in the picture.
You will need to have an empty bladder for your scan. It is also possible that you will need to prepare your bowels by taking a ‘micro enema’. Again, this will be explained to you. You can eat as normal for this appointment.

Planning scans are not diagnostic examinations and will not be reported on as such.

Important information about taking your Microenemas

Only use the microenemas on the days you are having radiotherapy. You do not need to use the microenemas on a weekend unless you are having a treatment session.

Please tell your radiographer if you are having frequent or loose bowel movements (loose poo). If you are taking laxatives for constipation please tell the radiographers when you come for your planning scan.

The scan will be taken with you lying in the same position as for your treatment. The radiographers will draw some marks on you, to be used as a reference for your treatment.
You will then be scanned, which will only take a few minutes. At the end of the scan the skin mark will be replaced by a small permanent mark (tattoo).

These permanent marks help us to ensure that you are in the same position each day. It also means that you can wash without worrying about your marks coming off.

Following the scan the radiographers will give you the time of your first appointment on the treatment machine. This is most likely to be a couple of weeks after the planning visit. The radiographers will talk to you about any further appointments you have.

Contrast (dye)

A special contrast agent, often called a dye, may be used for your scan to make specific organs, blood vessels and/or tissue types ‘stand out’.

This can make it easier for the oncologist to plan your treatment.

The dye is given through a very small plastic tube called a ‘cannula’ into a vein in your arm. You should tell the radiographer if you have any allergies, but they will go over this before they use any dye.

The radiographers will advise you about drinking plenty of fluid after your injection.

Contrast side-effects

You may notice a warm feeling throughout your body and have a metallic taste in your mouth. You may also feel as if you have passed urine. This will pass very quickly. There is a slight risk of an allergic reaction to the injection, such as a skin rash, but this very rarely leads to other complications.

The staff in the radiotherapy department are highly trained to manage any complications and again the risk involved is very small. You will be able to drive your car or go to work after your scan.

Having your treatment

When you arrive for your treatment you should go to the radiotherapy main reception desk at the entrance of the radiotherapy department. On the first occasion you will be given a list of all your appointments and be escorted to the waiting area for your machine. The radiographers will explain what will happen, including your bowel and bladder preparation, and answer any questions that you may have.

You may need to undress and put on a gown. You will also need to have an empty bladder for your treatment. The radiographers will explain this to you.
The radiographers will position you, and adjust the treatment couch and machine to the correct positions.

For the first few treatments and also intermittently during treatment we will also take images to check the accuracy of the treatment. This will take a few more minutes. These images do not monitor your condition but are purely for treatment accuracy.

Although you have the small permanent marks on your skin, the radiographers may need to draw around them each time you come for treatment. Please note pen marks may come off onto your clothing.

You will be asked to stay as still as possible during the treatment but you should breathe and swallow normally. Once you are in the correct position the radiographers will leave the room to switch on the machine. You will only be alone for a few moments at a time. The radiographers will be watching you on a closed circuit TV (CCTV) monitor during treatment. The CCTV camera is not recording or saving any images. There is also an intercom system so the radiographers can talk to you.

If you would like to listen to music during your treatment, please let us know.

The treatment only takes a few minutes but you will be in the treatment room for about 10-20 minutes. The machine stops automatically after your prescribed dose of treatment has been given. The radiographers can stop the machine at any time if needed. The treatment machine makes a buzzing sound when switched on. You do not feel anything.
The radiographers may need to come in and out part way through each treatment. After the treatment is complete the radiographers will come back into the room and help you off the couch.

On some days the radiotherapy department may be busy and there may be a delay before your treatment. We will keep you informed of any delays over 30 minutes, please see the delay signs in the waiting areas. It may be a good idea to bring something to eat and drink with you, including any supplement drinks you have been asked to have and any medication you may need. There is a restaurant and café available on Level 0.
It is very important that you do not miss treatment days as it may make your treatment less effective. If you feel you are unable to attend for any reason please ring us so that we can discuss this with you.

If you have any queries about your appointment times please discuss these with the radiotherapy co-ordinators on your treatment unit. You can also ring the Radiotherapy Main Reception desk on 0113 206 8940 for further advice.

Side-effects of treatment

Side-effects can be divided into short term (acute) effects that happen during or soon after your treatment, and long term side-effects occurring months or years later. Some side-effects are common, whilst others are rare.

The area and amount of treatment given to you will affect which side-effects are most likely to happen to you. Your oncologist will discuss this with you. If you develop any radiotherapy side-effects you will be given advice and support by your healthcare team.
Most side-effects are common and are temporary. Side-effects tend to build up from about the second week of treatment and will be at their worst at the end or just after the treatment course. They generally last a number of weeks or months after the treatment has finished.

Urinary symptoms

Radiotherapy for bladder cancer may irritate the bladder causing the following symptoms:

• A burning feeling when you pass urine (when you have a wee);
• A need to pass urine more frequently;
• A need to pass urine again as soon as you have been;
• May experience pain/discomfort down the penis.

It is important to try to drink up to two litres of fluid a day throughout your treatment and after. This helps to keep your bladder healthy and to replace any fluid loss, particularly if you have diarrhoea. Drinking 1-2 glasses of cranberry juice a day often helps to reduce the frequency of urine infections.

Other fruit juices may make the urine too acidic and make your symptoms worse. It may be helpful to avoid drinking strong coffee or tea and all alcoholic drinks as they may also irritate your bladder.

Depending on your symptoms we may need to test your urine to make sure you do not have an infection.

You may notice your urine has a red tint and you may see small particles (bits). This is caused by the radiotherapy and is not serious. However, please tell us if you notice any blood in the urine.

Bowel symptoms

Radiotherapy may irritate your bowel. It is important to tell your nurse or radiographer if you have loose motions (very soft poo) or diarrhoea (loose watery poo). This can be treated effectively with medication, though you will also have to stop using your micro enemas. You may develop the urge to open your bowels / poo without passing anything (this is called ‘tenesmus’), or you may find opening your bowels painful.

Abdominal pain (colic)

Abdominal (tummy) discomfort and colicky pains are rare side-effects of radiotherapy to the bladder. You may feel bloated and swollen.

Tiredness (fatigue)

Nearly all patients having radiotherapy will feel tired. Be prepared to take things easy during treatment and allow for extra rests. Try to continue with some of your normal routines and activities if possible. There is a Macmillan information leaflet available. If you would like a copy, or support with your fatigue please ask a member of staff.

There are things you can do to help yourself:

• Gentle exercise can help reduce the symptoms of fatigue.
• Having enough to drink can prevent tiredness from dehydration.
• Small meals or snacks eaten more often than three times a day may be easier to face.
• Try to get a good night’s sleep where possible, a daytime nap may help.
• Try to ‘pace’ yourself, listen to what your body is telling you, rest if you need to.
• Pick out the things that you enjoy, and try to delegate other tasks.
• Little and often is the rule of thumb.

Skin reaction

The skin in the treated area starts to redden or darken around 10 days after starting your radiotherapy. It may become dry and itchy. For a very small number of patients, it may peel and become weepy.

Avoid hair removal where possible, including shaving, waxing, cream and lasers unless advised otherwise by your consultant, nurse or radiographer.

Before you start your treatment the radiographer will explain what will happen to your skin and how to look after it.

They will also give you a leaflet to take home. If you are concerned about your skin reaction please talk to your radiographers or contact the review clinic nursing staff in the Princess Royal Suite, telephone: 0113 206 7587.

Sickness or nausea

It is rare to feel sick (nausea) with this treatment. If you do feel sick, drinking extra fluids and eating little and often may help. If the nausea persists anti-sickness tablets can be prescribed.

Other side-effects

Radiotherapy to the pelvis may cause you to lose some of your pubic hair (the hair around your genitals). When you have finished your radiotherapy the hair may grow back.
If you have had a history of piles (haemorrhoids), the radiotherapy can cause this problem to flare up again. Please inform your radiographer or other healthcare professional if this is a problem. Do not use over the counter medication for this. Our doctors will prescribe something for you.

After treatment

Any short-term side-effects you experience will gradually settle. You should start getting back to normal after about 3-4 weeks. Some side-effects may take longer to settle. You will be given an appointment to see the doctor about 6-8 weeks after the treatment has finished.

Possible late side-effects

Long term side-effects will depend on the exact details of your treatment.
If you are concerned about your risk of developing any of the following side-effects please speak to your consultant or specialist nurse.

Infertility

Radiotherapy to the pelvis is likely to cause infertility in patients of any gender. If this is a concern for you please discuss this with your consultant or nurse specialist.

Bowel frequency (how often you poo)

A slight increase in how often you open your bowels is common. It is important to tell your clinical oncologist when you are seen in case further investigation is needed.
Inflammation of the lining of the back passage (proctitis), may develop and needs to be treated.

The symptoms are:

• Pain or discomfort;
• Stools (poo) with blood in it;
• Discharge from the back passage.

If you have the above symptoms please telephone your consultant’s secretary for an earlier appointment.

You will find this number at the top of your outpatient appointment letter. Or you can ring St James’s Hospital switchboard on: 0113 243 3144, ask to speak to your consultant’s secretary.

Rare side-effects

The following effects are rare, but it is a good idea to know what to look out for.

Increased urinary frequency

You may have a smaller bladder capacity after radiotherapy. This may mean you need to empty your bladder (have a wee) more often. If this becomes a particular problem, treatments may be available that can help. Your clinical oncologist, urologist and GP will be able to advise you.

Vaginal Changes/Stenosis

Radiotherapy to the pelvis may result in a change to vaginal tissue which leads to narrowing and shortening of the vagina. Your vagina may become less elastic, drier and tender. This can make sexual intercourse and pelvic examinations quite difficult and painful. This can be avoided by keeping the muscle of the vagina as supple as possible.
Members of your treatment team will give you more information about how to deal with this, if this could be a problem for you. There is a leaflet covering this subject available for you to read; the radiographers will give you a copy.

Erectile Dysfunction

If you have a penis and are sexually active, there is some risk that the radiotherapy can make it difficult to get an erection (impotence). It may be some months after your treatment has finished before this happens. If you wish, you can talk to your clinical oncologist or nurse specialist about this. There are treatments which may help if this should happen to you.

Cancers caused by the radiotherapy

When you have had radiotherapy there is a risk that cancer can develop many years later. However this is rare. Please discuss this with your consultant.

Macmillan toilet card

If you want to go to the toilet more often, or feel that you can’t wait when you do want to go, you can get a card to show to staff in shops, pubs and other places. The card allows you to use their loos without staff asking awkward questions. You can get the cards from your radiographer.

Research at Leeds Cancer Centre

Leeds Cancer Centre is a major centre for cancer research. You may be asked if you would like to help with some of the clinical studies. You are under no obligation to take part in any trials, and your treatment will not be affected in any way if you do not wish to take part.

If you do take part in a clinical trial you may meet a research nurse or radiographer who will be helping to run the trial.

Further information and support

If you have any questions please ask your hospital team. We all have our own ways of coping with difficulties. Some people have a close network of family and friends who provide emotional support. Others would rather seek help from people who are not involved with their illness.

The following are also available as sources of information and support that you may wish to use.

Your Uro-Oncology Clinical Nurse Specialist

Your Clinical Nurse Specialist (CNS) is available to discuss any aspect of your treatment with you. Usually you will have already seen a CNS before your treatment at your local hospital. This is to offer support and advice about the practicalities and effects of your treatment and answer any questions you may want to ask.

Your CNS will also assess and discuss any physical, psychological, social, occupational and spiritual needs that you may have. They can refer you to other services if needed, for instance, benefits advice. You should be given a ‘Key worker’ as a contact for support through your treatment; this is usually your CNS.

Macmillan Specialist Radiographer and Macmillan Radiotherapy Nurse Specialist

Sometimes people need more help if they are feeling depressed, very anxious or are having problems with their treatment or accepting their diagnosis. If this is the case you may benefit from seeing the Macmillan radiographer or nurse specialist.
Your oncologist, radiographer or nurse can refer you at any point before or during your treatment.

Local Support Services

Leeds Cancer Support

Leeds Cancer Support complements care provided by your clinical team. We offer access to information and a wide range of support, in a welcoming environment for you, your family and friends.

We can be found in the information lounges in Bexley Wing and also in the purpose built Sir Robert Ogden Macmillan Centre (behind the Thackray Medical Museum).

The Sir Robert Ogden Macmillan Centre

This centre offers a variety of free health & wellbeing and supportive therapies for patients, their family members and carers. These include hypnotherapy, mindfulness coaching, acupuncture (for hot flushes) and pilates.

Contact numbers for Leeds Cancer Support

Maggie’s Centre

If you or someone you love has cancer you may have lots of questions. Maggie’s is a warm, welcoming place where you can meet people who are experiencing similar things to you.

You may also be able to find support groups specific to your needs and get advice and information from their professional staff. You don’t need an appointment and all support is free.

National Support Organisations

Hotel Bexley Wing

Patients having radiotherapy or chemotherapy sometimes use the hotel if they have a long way to travel. The hotel is located on the 8th floor of Bexley Wing and offers 19 twin rooms and 1 single room. All have en-suite, tea and coffee making facilities, a mini fridge, towels, hairdryer and digital television. There are two rooms with wheel chair access and a wet room. Patients are able to stay free of charge. There is a charge for relatives if they are staying in their own room.

Meals can be purchased (at breakfast and lunch) if you are able to make your way to the restaurant in the Bexley atrium. At other times you will need to have something you have brought from home or purchased.

There is a very small fridge for your personal use. There are no staff after 4pm until the next morning in this facility.

Car Parking

When you are coming for radiotherapy planning and treatment your parking is free in the on-site multi-storey car park. Please ask for more information at the radiotherapy main reception desk.

Refreshments

There is a restaurant and coffee shop available on Level 0, both are open daily. They serve drinks, light snacks and hot meals. Vending machines are also available in the main radiotherapy waiting room and Level 0. There is also a shop on Level 0 with books, papers and snacks.

How to find us

St James’s University Hospital – site plan