Chemoradiotherapy for bladder cancer
Chemoradiotherapy means having chemotherapy and radiotherapy treatment together. You might have chemoradiotherapy instead of an operation to remove your bladder.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. Radiotherapy uses high energy x-rays to kill cancer cells.
The chemotherapy helps the radiotherapy to work better.
When do you have it?
Your doctor might suggest you have radiotherapy as your main treatment instead of surgery. You usually have radiotherapy with chemotherapy. But radiotherapy is not a suitable treatment for everyone. Your doctor will tell you if it might be an option for you.
If you have chemoradiotherapy, you don't need to have surgery to remove your bladder. So this is sometimes called bladder sparing treatment.
You might have a course of chemotherapy on its own before chemoradiotherapy. This is called neoadjuvant chemotherapy.
How you have chemoradiotherapy
Chemotherapy
You usually have the chemotherapy during the 1st and 4th week of radiotherapy. You have treatment in the chemotherapy day unit or you might need to stay in hospital for a day or more.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris, my name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that ok?
Before you have each treatment, you’ll need to have a blood test to check your bloods are ok and you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15, then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having, we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods, so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot, so please be prepared to bring along some bits to keep you occupied - books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
There are different chemotherapy drugs, and different ways of having these drugs. Most often, for chemoradiotherapy you have a combination of 2 drugs:
- fluorouracil (5FU)
- mitomycin C
Or you might have other chemotherapy drugs, such as gemcitabine.
How you have it:
Week 1: You usually have an injection of mitomycin C into your vein on the first day of radiotherapy. You also have a drip (infusion) of fluorouracil into your bloodstream for 5 days.
Week 4: At the beginning of the 4th week you have the fluorouracil as a drip for 5 days.
You usually have your chemotherapy through a PICC line so you can go home with it. PICC stands for peripherally inserted central catheter. PICC lines are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in just before your treatment starts and it stays there as long as you need it.
Radiotherapy
Before you begin treatment, the radiotherapy team works out how much radiation you need. They divide it into a number of smaller treatments. They call each treatment a fraction. This is called radiotherapy planning.
Daniel (senior radiographer): “Before your treatment starts your doctor will need to work out exactly where the treatment needs to go, and also which parts need to be avoided by the treatment.
To have radiotherapy, you lie in the same position as you did for your planning scans.
We then line up the machine based on your tattoo marks.
It's really important that you stay very very still when you're having your treatment. It’s also important to let the radiographers know right at the beginning if you're not comfortable, so they can adjust your position”.
(Radiographer): “Ok, all done we'll be back in a couple of minutes”.
(Daniel): “We leave the room and control the machine from a separate room. This is so we aren't exposed to radiation.
Treatment takes a few minutes and you'll be able to talk to us using an intercom.
We can see and hear you while you're having your treatment and will check that you're OK.
When your treatment starts you won't feel anything. You may hear the machine as it moves around you, giving the treatment from different angles.
Because we're aiming to give the same treatment to the same part of the body every day then the treatment process is exactly the same everyday. So you shouldn't really notice any difference.
You'll see someone from the team caring for you once a week while you're having treatment.
They'll ask how you are and ask about any side effects”.
Jeff (patient): “They get you from one sitting area to another. And then take you into the room where you undress to the waist and then lie down. And line you up by either moving you or asking you to shuffle a little.
And they check the dimensions and they talk to one another, and they say I'm fine this side, how are you?
Yes fine, ok, stay where you are Jeff, and that was it.
A few little clicks and lights go on and off, and you can see a green laser beam which lines up with certain things on your body….so no, no real noise and no discomfort”.
You have radiotherapy treatment in the hospital radiotherapy department. Usually treatments are once a day from Monday to Friday with a rest at the weekend. For invasive bladder cancer this will last between 4 and 7 weeks.
Tests
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
Side effects
Everyone is different and the side effects vary from person to person. This treatment may cause more severe side effects than having radiotherapy or chemotherapy on its own.
Generally radiotherapy can cause:
- tiredness and weakness
- reddening or darkening of your skin
- passing urine more often
- inflammation of your bowel causing diarrhoea
- hair loss from your pubic area (this usually returns after you’ve finished treatment)
Chemotherapy side effects depend on what drug you have, how much you have and how you react to it. Side effects often include:
- feeling or being sick
- loss of appetite
- weight loss
- feeling very tired and weak
- a lower resistance to infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss (which usually comes back after you have finished treatment)
Chemotherapy before chemoradiotherapy
You might have chemotherapy before starting your course of chemoradiotherapy. This is called neoadjuvant chemotherapy. You usually have different chemotherapy drugs.
