نظرة عامة
Bladder radiation is a treatment for bladder cancer. It also may be called radiation therapy or radiation treatment. Radiation uses high-energy rays to kill cancer cells or stop them from growing.
When radiation is used to treat bladder cancer, it usually is given as external beam radiation therapy. This means a machine outside the body sends radiation toward the cancer.
Bladder cancer often is classified by how deeply it has grown into the bladder wall. Non-muscle invasive bladder cancer has not grown into the bladder muscle. Muscle-invasive bladder cancer has grown into the muscle layer. Radiation therapy is used mainly as part of treatment for muscle-invasive bladder cancer.
Radiation therapy is different from chemotherapy. Radiation is a local treatment. This means it treats a specific part of the body. Chemotherapy uses strong medicines to treat cancer. For some bladder cancers, chemotherapy and radiation are given together.
Radiation may be part of treatment that preserves the bladder. This is called trimodality therapy. It combines surgery with radiation therapy and chemotherapy. The aim of surgery is to take out as much of the bladder tumor as possible.
لماذا يتم ذلك؟
Radiation therapy may be used to treat muscle-invasive bladder cancer. This means the cancer has grown into the muscle layer of the bladder wall.
For some people, trimodality therapy is an option instead of surgery to remove the bladder. Surgery to remove the bladder is called radical cystectomy.
Bladder-preserving treatment isn't an option for everyone. This treatment may be right for you if you have:
- One bladder tumor.
- Good bladder function.
- No extensive areas of carcinoma in situ. Carcinoma in situ is a type of bladder cancer that grows along the bladder lining.
- Little or no blockage of urine from a kidney. This blockage is called hydronephrosis.
Your care team also may consider trimodality therapy if you don't want surgery to remove the bladder or if you aren't able to have that surgery.
Radiation without chemotherapy may be an option if you can't have surgery or chemotherapy. But radiation alone generally isn't recommended as a curative treatment for muscle-invasive bladder cancer if combined treatment is possible.
Radiation also may be used to ease symptoms when bladder cancer is advanced or has spread. This is called palliative radiation therapy. It may help ease:
- Bleeding.
- Pain.
- Painful urination.
- Blockage of urine.
For some people whose cancer has spread to only a few places, radiation may be aimed at those areas. This is sometimes called metastasis-directed treatment. More research is needed to know who is most likely to benefit from this treatment.
Radiation also may affect the bladder when it is used to treat another cancer in the pelvis. Pelvic radiation for another cancer has been linked to a higher risk of developing bladder cancer later in life. This is called a secondary cancer.
Bladder-preserving treatment
Bladder-preserving treatment usually starts with a procedure called transurethral resection of bladder tumor (TURBT). During TURBT, a surgeon takes out as much of the visible tumor as possible through the urethra. The urethra is the tube that carries urine out of the body. After surgery, you get radiation and chemotherapy together, also called chemoradiation.
Chemotherapy given during radiation can make cancer cells more sensitive to the radiation. This can help radiation work better against the cancer.
Studies have shown that adding chemotherapy to radiation can improve control of cancer in the bladder and nearby area compared with radiation alone. In one large study, at five years, 63% of people who had chemoradiation did not have their cancer return in the bladder or nearby area compared with 49% of people who had radiation alone.
The benefit of adding chemotherapy continued during long-term follow-up. The study followed participants for about 10 years.
المخاطر
Radiation can damage healthy cells near the treatment area as well as cancer cells. This can cause side effects. Side effects can vary based on the area treated, the radiation dose and other treatments given at the same time.
Radiation to the pelvis can irritate the bladder and urinary tract. This irritation often begins a few weeks after radiation starts. It often goes away several weeks after treatment ends.
Sometimes, radiation can affect bladder function. You may need to urinate more often or more urgently, or you may leak urine.
Irritation of the bladder lining from radiation is called radiation cystitis. Symptoms may include:
- Pain or burning when you urinate.
- Blood in your urine. This is called hematuria.
- Trouble starting to urinate.
- Trouble emptying the bladder completely.
- A need to urinate urgently or often.
- Urine leaks.
- Bladder spasms, cramps or discomfort in the pelvic area.
Some of these symptoms also can occur with a urinary tract infection (UTI). A UTI may cause pain or burning with urination, cloudy or red urine, fever, chills, tiredness, back or stomach pain, or trouble urinating. Your care team can determine what is causing your symptoms.
Tell your care team about urinary or bladder symptoms during treatment. Ask which symptoms need medical attention.
Radiation therapy for bladder cancer also may cause bowel issues. These may include diarrhea, an urgent need to pass stool, blood in your stool or trouble with bowel function. These issues usually improve after radiation treatment ends, but sometimes they continue.
Modern radiation methods use imaging and careful planning to limit radiation to healthy tissue near the bladder. Major long-term bladder or bowel issues occur in fewer than 5% of people treated with modern external beam radiation.
You may feel very tired during radiation therapy. This is called fatigue. It often starts after a few weeks of treatment and may get worse as treatment continues. Fatigue usually gets better over time after radiation therapy ends.
كيف تستعد؟
The bladder changes in size, shape and position as it fills and empties. For this reason, your care team may give you instructions about when to urinate or drink water before scans and treatments.
Some treatment plans use a full bladder. Others use an empty bladder. Some use both approaches at different points. There is no single approach used for everyone.
Follow your radiation therapy team's instructions before each treatment. These instructions help the team treat the planned area as safely and accurately as possible.
ما يمكن أن تتوقعه
Before the procedure
Treatment planning happens before your first radiation treatment. A computerized tomography (CT) scan is commonly used to map the bladder, the tumor and nearby tissues and to plan how you will get the radiation. Magnetic resonance imaging (MRI) also may be used to help show the tumor or nearby tissues in more detail.
The bladder can move and change shape as it fills. Image-guided radiation therapy can help the team check the bladder's position during treatment. Adaptive radiation therapy can use these images to choose or create a plan that matches the bladder's size and position that day.
If radiation is part of trimodality therapy, you usually have TURBT first. This procedure takes out as much visible tumor as possible. You then get chemotherapy along with external beam radiation therapy.
During the procedure
Before each treatment, follow your care team's instructions about drinking water or emptying your bladder. The care team may take images to check the bladder's size and position and make sure the treatment plan matches your bladder that day.
During external beam radiation therapy, a machine outside your body aims radiation toward the treatment area.
- Your care team positions you for treatment. You lie on a treatment table in the position planned for your radiation therapy. Supports or other positioning devices may be used to help keep you in the correct position.
- The radiation therapist moves to a nearby room. The therapist operates the machine from there and can see and talk with you during treatment. Tell the therapist if you feel ill or are not comfortable.
- The machine gives the radiation. You need to stay still during treatment. The machine may move around you to send radiation toward the cancer from different directions. It does not touch you, and you won't feel the radiation.
Treatment visits often take longer than the radiation itself because time is needed to position you correctly. The radiation treatment usually takes only a few minutes.
Bladder-preserving radiation usually is given in a series of treatments over several weeks. The number of treatments and length of treatment can vary.
After the procedure
You can go home after each external beam radiation treatment. The treatment does not make you radioactive.
Radiation doesn't kill all cancer cells right away. Cancer cells can continue to die for weeks or months after treatment ends.
Urinary and bladder issues caused by pelvic radiation often begin several weeks after treatment starts and go away several weeks after treatment ends.
Tell your care team if you have any of the following:
- Pain or burning when you urinate.
- Blood in your urine.
- Trouble urinating.
- The need to urinate often or urgently.
- Urine leakage.
- Bladder spasms.
Your care team can find out what is causing the symptoms and recommend ways to help you feel better.
النتائج
The goal of bladder-preserving trimodality therapy is to treat the cancer while keeping a working bladder. Guidelines recommend offering bladder-preserving treatment to people who want to keep their bladders and to some people who can't have radical cystectomy.
It is hard to directly compare trimodality therapy with radical cystectomy because studies have included different groups of people and used different methods. Treatment decisions consider your cancer, bladder function, other health conditions and treatment preferences.
Studies have shown that adding chemotherapy to radiation can improve control of cancer in the bladder and nearby area compared with radiation alone. Having both treatments also may reduce the chance that you will need surgery to remove the bladder later. However, one large study did not show clear evidence that adding chemotherapy helped people live longer than they did with radiation alone.
Follow-up is important after bladder-preserving treatment because bladder cancer can come back. After treatment, regular monitoring may include CT scans, cystoscopy and urine cytology. Cystoscopy uses a thin tube with a camera to look inside the bladder. Urine cytology checks urine for cancer cells.
If muscle-invasive cancer remains or comes back after bladder-preserving treatment, surgery to remove the bladder may be advised if you are able to have surgery.
التجارب السريرية
استكشِف دراسات مايو كلينك حول الاختبارات والإجراءات المخصصة للوقاية من الحالات الصحية واكتشافها وعلاجها وإدارتها.