Radiotherapy for bladder cancer
This booklet will help you understand what will happen when you come to Velindre hospital to have radiotherapy treatment to your bladder.
The booklet will explain how your treatment is planned and given. It will discuss side effects you may have and will tell you how to get more information and support.
A glossary is provided at the front of this booklet to help you understand any words that you may find unfamiliar.
Contact telephone numbers can be found at the end of the booklet.
We hope this answers your questions. Please ask us if you have other questions that we have not covered.
Patient information is available on Velindre website
Please go to: https://velindre.nhs.wales/velindrecc/
Smoking is not allowed within the grounds and inside Velindre Hospital. If you need help giving up please ask us.
This information is evidence based and is reviewed annually
Glossary of terms
Chemotherapy - a treatment for cancer using drugs
CT scanner (computerized tomography) - a machine that uses x-rays to take detailed scans of your body
Linear Accelerator or LA- a machine that uses high energy radiation to give radiotherapy treatment
Physicist - a person who does the technical planning of radiotherapy treatment
Therapeutic radiographer - a person who will plan or give radiotherapy treatment
What is radiotherapy?
Your doctor has decided you would benefit from a course of radiotherapy to your bladder.
Radiotherapy is a treatment for cancer using high energy radiation, usually x-rays. The type and amount of radiation that you receive is carefully calculated to damage cancer cells, stopping them from dividing properly so they are destroyed. Your treatment will be planned to avoid as much healthy tissues as possible. However some healthy tissue is affected which causes side effects.
Radiotherapy treatment can be given alone, after surgery or instead of surgery. It can also be given with or after chemotherapy.
Radiotherapy team looking after you
The doctor responsible for your care is called a Clinical Oncologist. They will prescribe your radiotherapy treatment. This will be planned by a team of physicists and planning radiographers. A team of therapeutic radiographers will give you your treatment.
Velindre is a teaching hospital so your team may include a student radiographer, student nurse or a medical student. If you don't want a student present during your clinic or treatment appointment, please tell us.
We will ask your name, address and date of birth every time you come to the radiotherapy department to avoid any confusion.
During your treatment you will be seen by the information, support and review team. The team includes specialist radiographers with extra training to advise you on how best to deal with any side effects. They can also prescribe medicines to help. They will provide information and support on any practical, financial or emotional concerns you may have while you are having your treatment. You can speak to them at any point through your treatment; their number is at the end of this leaflet.
How many treatments will I need?
Radiotherapy is normally given Monday to Friday as an outpatient. The number of treatments you will need depends on many facts about you and your particular type of tumour. Your doctor will decide how many treatments are best for you.
Transport to and from Velindre
Hospital transport is available but most people use their own transport. If you would like to use hospital transport, please give us as much notice as possible to arrange this for you. There is a high demand for transport so you will need to be prepared to wait for some time to be picked up and taken home. Spaces are limited so please consider travelling alone. Some local charities can also arrange transport. Also, patients on particular benefits can claim travelling expenses, please ask when you come for your treatment.
Planning your radiotherapy
To plan your radiotherapy you will need to have a CT scan. We will give you an appointment to go to the planning department which is at the front of the hospital. This scan gives your doctor a detailed picture of the area that needs treatment.
You may see your doctor during this appointment if you have not signed a consent form for treatment. The doctor will discuss the benefits and risks of radiotherapy. It is your decision to go ahead with treatment, so please discuss any concerns you have before signing your consent form.
If you have already signed your consent form for treatment during your outpatient appointment you may only see the planning radiographers. They will explain everything that is going to happen to you.
The scan will be done with you lying in the position you will need to be in for your treatment. The scan procedure will only take between 10-20 minutes.
Picture of a CT scanner
We will ask you to empty your bladder before we take you in for your scan. You will also need to do this at each of your radiotherapy appointments.
We may ask you to take off some of your clothing or give you a gown to wear. We will ask you to lie on the couch which is quite hard, with your arms resting on your chest. Please tell us if you are not comfortable because you will need to keep this position, breathing normally, while we do the scan and for each day of your treatment.
During the scan, you will not see or feel anything. The radiographers will leave the room to turn the scanner on, but they will watch you very closely through a large window.
We will need to draw small pen marks on your skin, which will help us to make sure you are straight during your treatment. We will ask you if you are happy for us to make tiny permanent dots of these marks. To make these dots we use the tip of a sterile needle to place black ink just under your skin. The permanent marks are as tiny as a freckle. This means we have accurate marks to position you for your treatment every day, so you are able to wash during treatment.
A picture of permanent ink dot
Starting your treatment
There can be a few weeks in-between your planning scan and the start of your treatment. This is due to the time needed to plan your treatment and when the next free slot is available on your treatment machine.
Please let us know if there is any time that you would be unable to come for treatment. We will take this into account when your appointments are being booked. Please tell us if you have any special needs that may affect your appointments, such as:
- needing transport
- having any other treatment (chemotherapy for example)
We will send you a letter or call you with your first appointment. We will give you the rest of your appointments when you come for your first treatment.
If you have a problem with your appointment, please phone the radiotherapy booking clerk as soon as possible. If the answer machine comes on please leave your name and phone number slowly and clearly. We will ring you back as soon as possible.
Your first radiotherapy treatment
If you are an outpatient, please come to the radiotherapy entrance which is at the back of the hospital. Give your name and hand your letter to the receptionist in the radiotherapy waiting room. They will tell you where to sit and wait or direct you straight to your treatment machine.
If you are an in-patient, one of the hospital porters will normally collect you and take you to the treatment machine. You may be treated at any time in the day, depending on when there is a free slot on the treatment machine.
Your radiographers will chat to you before you go in for your first treatment. We will explain what will happen during your treatment and the possible side effects you may experience. We will give you a leaflet about skin care during your treatment. Please ask any questions you have so we can put your mind at rest. We may need you to re-sign your consent form before you have your first treatment.
There are different types of treatment machines but most people have their treatment on a Linear Accelerator (shortened to Lin Acc or LA). They each have a number; so for example, you may have your treatment on LA 4 or LA 5. The LA machines may look and sound different but they give the same treatment.
During your radiotherapy treatment
Before taking you in to the treatment room we will ask you to empty your bladder. In the treatment room, we will ask you to lie on the couch in the same position you were in for your planning scan. We will position you carefully using the permanent reference marks made at planning. You will need to lie still and breathe normally.
Your treatment may be delivered from different angles. On your first day of treatment we check your position at each of these angles before leaving the room to start your treatment.
The machine can be controlled and moved by the radiographers outside the room. When the machine is moving, it may come close to you but it will not touch you. When the machine is switched on you won’t feel anything, but you may hear it buzzing.
We will watch you carefully on television monitors. If you feel uncomfortable while the machine is on please wave your hand. We can switch the machine off and restart the treatment when you are comfortable again.
Having treatment on a linear accelerator
Usually on your first day of treatment and at regular points afterwards, we will take images of the area that is being treated. The images are only used to ensure you are in the correct position for your treatment.
You will need to lie still on the treatment couch for about 10-15 minutes, but the treatment itself (when you hear the buzzing noise) usually only takes a few minutes. When your treatment is finished, the couch is at a high level so please stay still until we have lowered the couch. You can then get off and leave the treatment room. The treatment procedure is the same everyday.
Short term side effects of radiotherapy treatment
Any side effects that you experience normally start after about 2 weeks of treatment. Side effects only affect the part of the body that we are treating.
Radiotherapy continues to work inside your body for about 2 weeks after you have finished your treatment so any side effects you experience will continue for this time. After about 2 weeks you will begin to recover, but the length of recovery is different for each person.
Tiredness
Radiotherapy can make you feel more tired than usual. You should listen to your body and rest if you need to but continue your normal activities if you feel able. Gentle exercise such as walking has been shown to be helpful.
Cystitis (burning when you pass water)
The treatment will irritate your bladder and cause symptoms such as burning when you pass water. You may find you need to pass water more often, particularly at night. You may find it more difficult to pass water. Drinking lots of water and avoiding caffeine during treatment will help. Please tell your radiographers if you are having any of these symptoms.
Diarrhoea
The treatment may cause some diarrhoea and increased wind or you may pass some blood. You may experience bloating and cramps. Please ask your radiographer for advice on how to manage this.
Piles (haemorrhoids)
If you have suffered from piles before, the radiotherapy treatment may irritate them. Please ask to see the review radiographers who can prescribe medication to help.
Skin reaction
Your skin within the treatment area may turn pink, feel warm and tender. We do not expect much skin reaction when giving radiotherapy to the bladder. We encourage you to continue your normal skin care routine during treatment; we will discuss skincare with you on your first treatment.
Late side effects
Longer term side effects are rare and don’t happen to everyone. They can develop months or even years after the treatment has finished. Your doctor will discuss this with you.
The treatment will cause your bladder to be smaller so you will pass water more often.
A very small part of bowel tissue can be treated, which can affect your normal bowel habit, causing occasional diarrhoea and bleeding from the back passage.
For men, having radiotherapy to the pelvis area can reduce the ability to get an erection. If you are concerned about this there are treatments available to help. Please contact your doctor, urology nurse or review team about treatment options.
For women who have not been through the menopause yet, radiotherapy may cause this to happen. You may have sweating (especially at night), hot flushes, irritability and mood swings, vaginal dryness and lack of sex drive. Please speak to your doctor or review team if you are concerned about these symptoms.
Finishing your treatment
At the end of your treatment we will give you a follow up appointment with your doctor. This will usually be between one to six months after finishing your treatment. We will give you a follow up form which details your appointment, and has the telephone number of the review team to contact if you are worried about your treatment side effects after you have finished.
If you need to change your follow up appointment, please ring your doctor's secretary via the main Velindre Hospital telephone number.
During future follow up appointments, you will have a procedure called a cystoscopy. This involves a special tiny camera being placed inside your bladder so the doctor can clearly see and check your bladder lining.
Contact telephone numbers
Velindre Hospital - 029 2061 5888
Information, support and review radiographers - 029 2061 5888 ext 6421
Urology Specialist Nurse - 029 2061 5888 ext 4680
Radiotherapy booking clerks - 029 2019 6836
Transport from Aberdare
The Rowan Tree Cancer Care - 01443 479369
Transport from Bridgend
Sandville - 01656 743344
Transport from Merthyr
Cancer Aid Merthyr - 01685 379633
Helplines and websites
Tenovus (freephone helpline) - 0808 808 1010
Macmillan Cancer Support - 0808 808 0000 www.macmillan.org.uk
F.PI 3 Issue 9 July 2019