Whole-body treatments for bladder cancer refer to radiotherapy and chemotherapy. If you have been diagnosed with muscle-invasive bladder cancer or treatments for high-risk non-muscle invasive bladder cancer have not been successful, you may be looking at these options.
You may have been told that surgery is an alternative – please read our page on bladder removal. Usually your multi-disciplinary team (MDT) will explain the options open to you so you can make an informed choice.
This page describes the different types of whole-body treatment and what to expect.
Radiotherapy can be an alternative treatment option for muscle-invasive bladder cancer and it is seen to be as effective as surgery for most people.
It uses a type of external x-ray treatment that uses carefully measured doses of radiation to destroy cancerous cells and therefore shrink tumours in order to achieve a cure. It is given by a machine that beams the radiation at the tumour cells in the bladder. These abnormal cancer cells are more sensitive to radiotherapy than normal cells and will be destroyed.
Sessions of external radiotherapy for bladder cancer are usually given on a daily basis for five days a week, over the course of four to seven weeks, each session lasting for about 10 to 15 minutes, although the number and frequency of radiotherapy sessions will depend on the extent, size and type of the tumour. Radiotherapy is often preceded by chemotherapy into the veins to improve the overall results of treatment.
The likelihood of success with radiotherapy treatment is the same as cystectomy in terms of the chance to be cancer free. It tends to be preferred over surgery for patients who have other health problems or who are older and therefore the risks associated with surgery are greater. Many younger and fitter patients, especially those with good bladder function, choose radiotherapy because the results are comparable with surgery, and the treatment is carried out as an outpatient and many patients carry on with their normal activities of life during the course of treatment.
Always make sure you let the radiographers know exactly how you feel and whether you experience any side-effects.
Radiotherapy can also be used to help control the symptoms in cases of incurable bladder cancer, this is known as palliative radiotherapy. This is given in between one and ten schedules and may be given either on a daily basis for one to two weeks or once a week.
For more information on radiotherapy including side effects and tips from patients, download or order a copy of the Muscle-invasive bladder cancer booklet (see link at the bottom of the page).
‘I found planning for my first session of treatment the most anxious time. It was so new and unfamiliar. Now I am in the swing of it, it is all matter of fact and I’m not at all worried.’
This section is about chemotherapy treatment injected into the bloodstream. These treatments, which can also be called systemic chemotherapy, reach all areas in the body that have a blood supply.
The doctor may be able to give you information on the improvements expected from each treatment in your individual case. Remember when you are quoted statistics that they apply to a group of patients, some of whom may do much better than the average, and some who will do not quite as well.
Chemotherapy is often given before radiation therapy for muscle-invasive bladder cancer and also before radical cystectomy. This is called neoadjuvant treatment, meaning before the main treatment. Neoadjuvant chemotherapy in suitable patients has been shown to improve survival.
Concurrent chemotherapy is given alongside radiotherapy to make the cancer cells more sensitive to the radiotherapy.
This can include giving it alongside treatments 1 to 5 and 16 to 20 of radiotherapy, usually using a combination of drugs given through a special drip called a PICC line so the drugs drip into the system 24 hours a day for five days. All this can be done while you are going about life as normal and you do not need to be in hospital.
Doctors can use a treatment called BCON. This involves taking nicotinamide vitamin tablets before radiotherapy and breathing carbogen (high-dose oxygen) throughout the treatment, which makes the cancer cells more sensitive to radiotherapy. Your doctor will give you more information about this if you are suitable.
This form of chemotherapy is additional to the main treatment, such as an RC, to try to reduce the chance of the cancer returning. This is not usually given if you have had neoadjuvant treatment.
Your oncologist should give you a detailed patient information sheet. Read it carefully and share the information with family members, friends or a Bladder Buddy to make sure you have understood everything correctly. Write down any questions that you have to ask the medical team.
It is also worth buying a thermometer and practising so that you can take your own temperature accurately. You will then be able to monitor your temperature during any chemotherapy treatment if you feel unwell in any way as a raised temperature can indicate an infection.
‘My anticipation and worry were worse than the actual treatments. Try not to let your mind run wild with disastrous scenarios. Thinking positively changed my experience.’
This means that your medical team cannot cure the cancer but can give you treatment to improve symptoms and extend life — hopefully of good quality. It does not mean that you are terminal. Doctors use the phrase terminal to mean someone for whom there is no treatment available that targets the cancer.
For more information on chemotherapy including side effects and tips from patients, download or order a copy of the Muscle-invasive bladder cancer booklet (see link at the bottom of the page).
3. Intravesical chemotherapy
This section is about chemotherapy medication installed directly into your bladder. It is called intravesical chemotherapy.
If your cancer was diagnosed as intermediate-risk, non-muscle-invasive bladder cancer, you may also have a second TURBT, usually followed by intravesical chemotherapy. The treatment you are offered will depend on what your medical team recommends and what hospital facilities are available. Trials may also be offered to some patients.
Intravesical chemotherapy is a course of chemotherapy installed directly into your bladder once a week for six weeks. It involves placing a liquid solution of chemotherapy medication directly into your bladder using a catheter. The solution will be kept in your bladder for one or two hours before being drained away. It is not the same as chemotherapy given into the veins for much more advanced bladder cancer and does not affect your immune system.
IMPORTANT! Some residue of the chemotherapy medication may be left in your urine, so be careful not to splash yourself or the toilet seat with urine because it could irritate your skin. After you have had a wee, you can gently rinse the skin around your genitals.
The advantage of using this type of treatment is that, because the chemotherapy medication is placed inside your bladder rather than being injected into your blood, you are much less likely to experience the side-effects that are most commonly associated with chemotherapy, such as nausea, fatigue and hair loss.
For more information on intravesical chemotherapy including side effects, download or order a copy of the Low-risk and intermediate risk non-muscle-invasive bladder cancer booklet (see link at the bottom of the page).
A great deal of research is underway to develop knowledge in the fight against bladder cancer; new studies are being established, and new treatments are being offered. There are new clinical trials of immunotherapy and targeted therapy drugs for advanced cancer. Find out more about all these options on our new treatments page.
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