Radiotherapy treats cancer by using high-energy rays, which destroy the cancer cells while doing as little harm as possible to normal cells. 

Invasive bladder cancer

Radiotherapy for bladder cancer is often given instead of an operation to remove your bladder. However, if the cancer comes back later on you may still need to have your bladder removed. You will need to have cystoscopies (usually every three months or so) after your radiotherapy to check that the cancer has not come back.

You may have chemotherapy given before your radiotherapy treatment. Some people can have chemotherapy at the same time as their radiotherapy to help make radiotherapy more effective. This is called chemoradiation.

Advanced bladder cancer

If your cancer has spread outside the bladder to other parts of the body you may be given a short course of radiotherapy to the bladder. This can help to shrink the cancer and relieve symptoms that it may be causing. If your cancer has spread to the bones you may be given radiotherapy to help to relieve pain.

Our section on secondary bone cancer may be useful.

When you’re having radiotherapy to relieve symptoms it’s usually only given for a few minutes over one to three days. This means that you don’t get many side effects or if you do they only last for a very short time. This type of radiotherapy is called palliative radiotherapy because it’s given to ease (palliate) symptoms.

This treatment is normally given in the hospital radiotherapy department as a series of short daily sessions. The treatments are usually given from Monday to Friday, with a rest at the weekend. Each treatment takes 10–15 minutes. Your doctor will discuss the treatment and possible side effects with you.

A course of radiotherapy for bladder cancer may last 4–7 weeks. It’s usually given to you as an outpatient. If you are having radiotherapy to relieve symptoms you will usually only need a few short sessions.

External radiotherapy does not make you radioactive and it is completely safe for you to be with other people, including children, throughout your treatment.

Radiotherapy has to be carefully planned to make sure that it is as effective as possible. This may take a few visits. On your first visit to the radiotherapy department, you will be asked to lie under a machine called a simulator, which takes x-rays of the area to be treated.

The treatment is planned by a cancer specialist (clinical oncologist). Marks are usually drawn on your skin to help the radiographer (who gives you your treatment) to position you accurately and to show where the rays will be directed. These marks must stay visible throughout your treatment, and permanent marks (tiny tattoos) may be used. These are tiny and will only be done with your permission. It may be a little uncomfortable.

At the beginning of each radiotherapy session, the radiographer will position you carefully on the couch, and make sure you are comfortable. During your treatment you will be left alone in the room but you will be able to talk to the radiographer who will be watching you from the next room. Radiotherapy is not painful but you do have to lie still for a few minutes while the treatment is being given.

After positioning you will be left alone for a few minutes while treatment is given, but you can still talk to your radiotherapist by intercom.

Radiotherapy to the bladder area may irritate the bowel and cause diarrhoea and soreness around the anus (opening of the bowel to the outside). It can also cause inflammation of the bladder (cystitis) which makes you want to pass urine more often and causes a burning feeling when you pass urine. Your doctor can prescribe medicines to reduce this. These effects usually disappear gradually a few weeks after the treatment has ended.

Effects on the skin

Perfumed soaps, creams or deodorants may irritate the skin and should not be used during the treatment. At the beginning of your treatment you’ll be given advice on how to look after the skin in the area being treated.

Effects on the vagina

For women, radiotherapy to the pelvis can make the vagina narrower, and this can make sex difficult or uncomfortable.

This can be avoided by keeping the muscles in the vagina as supple as possible. Hormone creams applied to the vagina can help and these can be prescribed by your doctor.

One of the best ways of overcoming this problem is to start having sex regularly as soon as you feel ready. If you do not have a regular sexual partner you can use a vaginal dilator. Your nurse or doctor can show you these and explain how to use them.

Effects on ability to have erections

For men, radiotherapy to the pelvis can make it more difficult to have an erection. There are different treatments which can help. Our sections on sexuality and pelvic radiotherapy in men have more information about this.

Tiredness

Radiotherapy can also cause general side effects such as tiredness. These side effects can be mild or more troublesome, depending on the strength of the radiotherapy dose and the length of your treatment. The radiotherapist will tell you what to expect.

It’s important to try to get as much rest as you can, especially if you have to travel a long way for treatment each day.

Loss of pubic hair

During radiotherapy to the pelvis you may lose some of your pubic hair. When you have finished the course of treatment, the hair will often grow back. However, the hair may be thinner than it was before.

After your radiotherapy treatment you will have regular cystoscopies to check the inner lining of the bladder for any recurrence of the cancer.

In a small number of people, the bowel or bladder may be permanently affected by the radiotherapy. If this happens the increased bowel motions and diarrhoea may continue, or you may need to pass urine more often than before. The blood vessels in the bowel and bladder can become more fragile after radiotherapy treatment and this can make blood appear in the urine or in bowel movements. This can take many months or years to happen. If you notice any blood in your urine or stools it is important to let your doctor know so that tests can be done and appropriate treatment given.

We have further information about treatments for the long-term side effects of pelvic radiotherapy.

Infertility

Radiotherapy to the pelvic area is likely to cause infertility in men and women. If you have concerns about your fertility it’s important to talk to your doctor before your treatment starts.