This information is for patients who are going to receive radiotherapy to the bladder. It will explain what to expect when you attend for planning and treatment and details the services
that are available to you.
You might also find it helpful to read our booklet called 'Radiotherapy' which describes what to
expect when you come to the hospital.
The Clatterbridge Cancer Centre Hotline 0800 169 5555
If you are unwell during or up to 8 weeks following your cancer treatment, please call The Clatterbridge Cancer Centre Hotline. Your call will be answered by a dedicated nurse advisor. This line is available 24 hours a day, 7 days a week.
Radiotherapy is used:
- As an alternative to surgery
- In combination with chemotherapy
- In advanced disease to control symptoms, e.g. when passing a large amount of blood
Your doctor will explain why they have recommended radiotherapy for you, and what you can expect.
Chemotherapy can be used at the same time as radiotherapy in the treatment of bladder cancer. If this applies to you, it will be discussed in detail.
A Clinical Nurse Specialist (CNS) is available to all patients (and/or carers) who have a diagnosis of bladder cancer. They provide a link between medical, nursing, radiotherapy and other members of the multi-professional team.
Their aim is to assist with the continuity of care for patients who are receiving radiotherapy as an outpatient and for those who are not already linked with a Urology Nurse.
Please talk to your Therapeutic Radiographer if you feel this service would be useful for you.
When you attend Clatterbridge Cancer Centre - Liverpool or Clatterbridge Cancer Centre - Wirral for your planning CT scan appointment, we will ask you to visit the toilet to empty your bladder. Please do so using your normal amount of force and time. Do not strain to empty every last drop of fluid.
Treating the bladder when ‘empty’ allows the use of smaller treatment fields.
We will also ask you to use a small enema to empty your rectum (back passage). This will be repeated at every treatment appointment.
By emptying your bladder and rectum each time you attend for treatment, we can be sure these organs are in the same position for every treatment, making it more effective. However, it is important to eat and drink normally before you attend.
Every patient is different and you may not have the same side-effects as someone else. Your doctor will talk to you about the side-effects that are likely to affect you.
Most are temporary, but some may last for weeks or months after your treatment has finished (see possible long-term side-effects). Long-term or permanent effects can occur, but are fairly rare. Often, these effects can be easily managed and may not have a marked effect on your life.
During your treatment, a Therapeutic Radiographer or nurse will be able to answer any questions and deal with most of your problems. However, your doctor can also see you if necessary.
As you go through your treatment, how you feel and your ability to cope may change. It is important to let staff know how you feel, so that we can give additional information, support, and medicines etc.
Treatment is usually given on an outpatient basis, but for some it may be necessary to come into our hospital ward to help you cope with your side-effects, though this is rare.
You will be reviewed during your treatment and given advice and medicines, if necessary, to help you cope. It is important to let us know when your side-effects start.
The usual pattern for the development of the short-term (acute) side-effects is to gradually start about 5-10 days after the first treatment. They usually persist and worsen, the effects being most troublesome about 10 days after the last radiotherapy treatment. After this, the healing process begins.
The side-effects usually settle over the following 2-3 weeks, but sometimes effects may persist for months.
Your bladder
The treatment will irritate your bladder. You will probably feel the need to pass urine more often and you may feel a burning sensation. You may also notice a slowing of the stream of urine and feel an urgent need to pass urine. You may also notice blood and debris in your urine; do not worry, this is quite normal. In most cases, it will settle within a month of finishing your treatment.
You can help yourself by:
- Drinking more fluid; about 4 pints or 2 litres of fluid each day until the symptoms settle. Avoid large quantities of caffeine (tea, coffee, energy and cola-type drinks)
- If you wish, you may take alcohol in moderation, but stop if it causes irritation in your bladder
- Letting us know if you develop a burning sensation when you pass urine; if this sensation is severe, you may have an infection. If so, we will give you antibiotics and your treatment will carry on
Unable to empty your bladder during and shortly after the course of radiotherapy?
This happens rarely. The urethra is a tube which connects the bladder to the outside of body. Inflammation can cause it to be squeezed, making it difficult or impossible to pass urine. If you can’t pass urine at all, contact us immediately on The Clatterbridge Cancer Centre Hotline (24 hours) on 0800 169 5555 as not being able to pass urine can make you very unwell. You may need a catheter for a short time.
Your bowels
The treatment is likely to irritate your bowels. This symptom is more likely if you are having the whole pelvis treated.
You may have to open your bowels more often or occasionally they become stubborn. If your bowel habits change, advice on changing your diet may be appropriate as many people find this helpful. Meanwhile, carry on with your normal diet. A dietitian is available for you to talk to about your diet and we will arrange an appointment, if required.
You may also feel the urge to open your bowels, passing only small amounts or just mucus and wind.
You may have discomfort and you may pass some blood.
You can help yourself by:
- Letting staff know about any symptoms, so that they can give you advice and/or medicines
- Eating a good balanced diet
- Washing the area around your anus (opening of the bowel on the skin) gently and applying a cream as recommended by your Therapeutic Radiographer, nurse or doctor, to soothe and moisturise, if necessary
Pain and discomfort
Radiotherapy can cause pain or discomfort. This can be relieved by using painkillers and other medication, as required. It is important to treat this so that you can continue, if possible, with your normal activities.
Tiredness
It is quite common to feel more tired than usual for several weeks after your treatment has finished. It is important to rest when you feel the need to do so. Accept any offers of help. If you live alone, do only the things that are essential. After finishing your treatment, contact your GP (or District Nurse if you have one) if you feel that this is causing you difficulties, especially if it is affecting your eating and drinking. Gradually, you will get back to normal activities.
Your pelvic skin and pubic hair
Your skin is unlikely to be severely affected; it may become slightly red, dry and itchy. We can give you creams to soothe the skin.
You can help yourself by:
- Wearing loose fitting clothes made from natural fibres, such as cotton, to allow the air to circulate around the treatment area
- Speak to the Therapeutic Radiographers if you experience any skin changes or your skin becomes uncomfortable.
Temporary thinning or loss of pelvic hair can occur. The loss of pubic hair is most likely to be noticed.
Sexual activity, contraception and fertility
If you are sexually active, you can continue to be so while you are having radiotherapy. However, the side-effects of radiotherapy can cause temporary discomfort in the pelvic area. You may find that intercourse is uncomfortable or you have no desire for sex. If so, try to talk to your partner and explain how you feel.
If you are sexually active and conception is a possibility, it is important to use contraception while you are having radiotherapy. After completion of radiotherapy, effective contraceptive precautions should be used for at least one year. Individuals of a child-bearing capacity should avoid getting pregnant while receiving radiotherapy, as radiation is harmful to the unborn child. (See possible long-term side-effects).
Radiotherapy to the pelvic area is known to affect fertility. Retaining your fertility after completion of radiotherapy may or may not be important to you. If required, you will be referred to a local specialist centre for further advice and information. Ideally, it is important to be referred before starting your radiotherapy.
Radiotherapy can cause long-term changes to the normal tissues in your pelvis. These effects may appear months or years after treatment and often respond to simple treatments. Many people do not develop long-term side-effects.
If you develop any health problems that you suspect may be related to your radiotherapy, you should discuss this with your GP. If necessary, your GP can arrange for further investigation and/or an appointment with your oncology doctor.
Your bladder is likely to be a bit smaller after treatment, so you may need to empty your bladder more often. You may see some blood in your urine; this should be reported to your GP A few people have ongoing problems with blood in the urine. This is rare, but usually responds to further interventions arranged via a Urologist. Occasionally, surgery may be required.
Following treatment, some incontinence may occur. For many this is temporary and settles over 3-6 months. Should this be an ongoing problem, you can be referred to a continence team via your oncology doctors or GP Further information about incontinence and products are listed in the references section.
Radiotherapy can cause long-term changes to the normal tissues in your pelvis. These effects may appear months or years after treatment and often respond to simple treatments. Many people do not develop long-term side-effects.
If you develop any health problems that you suspect may be related to your radiotherapy, you should discuss this with your GP. If necessary, your GP can arrange for further investigation and/or an appointment with your oncology doctor.
Your bladder is likely to be a bit smaller after treatment, so you may need to empty your bladder more often. You may see some blood in your urine; this should be reported to your GP A few people have ongoing problems with blood in the urine. This is rare, but usually responds to further interventions arranged via a Urologist. Occasionally, surgery may be required.
Following treatment, some incontinence may occur. For many this is temporary and settles over 3-6 months. Should this be an ongoing problem, you can be referred to a continence team via your oncology doctors or GP Further information about incontinence and products are listed in the references section.
The diagnosis of cancer together with the impact of treatment and any side-effects can have a major impact on how you feel, which then affects how you behave. Sometimes, your relationship(s),
including sexual intimacy, are affected. If you are able, talking to staff about how you feel can be a great help.
Sometimes, more help is required to help you cope and overcome any negative feelings. Often, these feelings become more apparent once you have completed all your treatments and you are beginning to recover.
You should discuss these issues with your GP or your Oncologist at your follow-up appointments. Referrals to specialist staff, e.g. a psychologist or sexual health advisor, alone, or with your partner, can be beneficial.
Macmillan booklets about coping and living with cancer and treatment side-effects are available, free of charge. These can be ordered by telephoning 0808 808 0000 or by visiting the Cancer Information and Support Centre (sited in the main entrance of Clatterbridge Cancer Centre - Liverpool).
If you are feeling low or experience mood swings, it may be useful to talk about how you feel and your recent experiences. Some find it useful to have the support of others who have experience of cancer by attending a local support group. Contact the Cancer Information & Support Centre for more details.
Maggie's is a charity providing free cancer support and information to anybody who been affected by cancer. Our Cancer Nurse Specialists, Psychologists and benefits advisors are here to support you during treatment or after your treatment has finished.
The Maggie's Centres allow you to share experiences with others in a similar situation around our kitchen table. We provide courses on survivorship, bereavement, stress management, mindfulness, tai chi, yoga, relaxation or cancer support groups.
You do not need an appointment or a referral to access any support from Maggie's, you can just drop in. Our telephone number is 0151 334 4301.
Alternatively, if you are familiar with using the internet, the major cancer charity websites have online communities.
If you find that you have long or frequent periods of low mood, you should seek help from your GP. There are many ways to be helped.
Are you a smoker?
Smoking is a major cause of bladder cancer. If you are a smoker, we strongly advise you to quit. Help and support to do so is available, free of charge from The Clatterbridge Cancer Centre staff or your GP.
Clatterbridge Cancer Centre - Liverpool
65 Pembroke Place, Liverpool, L7 8YA
Tel: 0151 556 5000
www.
Clatterbridge Cancer Centre - Wirral
Clatterbridge Road, Bebington, Wirral, CH63 4JY
Tel: 0151 556 5000
www.
Clatterbridge Cancer Centre - Aintree
Lower Lane, Fazakerley, Liverpool, L9 7AL
Tel: 0151 556 5959
www.
Macmillan Cancer Support
89 Albert Embankment, London, SE1 7UQ
www.
Tel: 0808 808 0000
Cancer Information and Support Centre
Clatterbridge Cancer Centre – Liverpool
Tel: 0151 318 8805
Smokefree.nhs.uk or 0800 022 4332
Age UK (was Age Concern)
www.
Bladder and Bowel Foundation
www.