Chemotherapy

Radiation

The side effects directly attributed to the radiation are frequency of urination, nocturnal urination (being awakened from sleep to urinate), urgency of urination, rectal irritation, and diarrhea. These side effects are caused by the radiation dose to the bladder and rectum. By using modern treatment planning systems, doctors can minimize the dose to the rectum.

Allowing a month to pass between the bladder biopsy and the first treatment can minimize radiation side effects. Obstruction of the ureters caused by the cancer is treated by inserting tubes (stents) to bypass the obstruction.

Antibiotics are given to patients with bladder infections, which, while not common, can occur.
In general, side effects during the seven or eight weeks of radiation therapy are moderate. It is common for the bladder to become irritated, thus producing urinary frequency, some burning, and urgency. These symptoms are well controlled with appropriate medications—phenazopydine (Pyridium) or oxybutynin chloride (Ditropan), for example. Warm baths, especially prior to going to bed at night, are also helpful in reducing urinary urgency.

The side effects must be distinguished from symptoms of urinary-tract infection (UTI), because bladder irritation caused by the radiation can mimic an infection or coexist. Therefore, a urinalysis may be done to determine if the patient has an infection; both antibiotics and medications to relieve bladder irritation are typically prescribed in such cases.

Bowel symptoms may also be present, because radiation affects the rectum and the lower intestine. Patients will experience diarrhea, cramping, and an urge to evacuate even when no fecal material is present. (The latter is called tenesmus.) Lomotil or Imodium A-D are medications used to relieve diarrhea and cramping.


Irritation in the rectal area may require a medication such as Anusol HC suppositories or Proctofoam enemas to relieve symptoms. Moderate reddening of the skin over the area receiving radiation, particularly between the folds of the buttocks, can be treated with soothing skin creams or cortisone ointments. These and other symptoms can be controlled, and most patients are able to continue radiation treatments without major difficulty.

A minority of patients may have long-term side effects following radiation treatment. These include occasional bleeding from the bladder, known as hemorrhagic cystitis, and bladder contraction with decreased ability to retain urine. A few patients may develop an obstruction or bleeding from the small intestine.

Chemotherapy

The most common side effects from chemotherapy include fatigue and malaise. Nausea is not as big a problem as it was before the routine use of antiemetics. There may be hair loss, but the hair will ultimately return. The patient’s blood count must be monitored closely, as the combination approach may cause significant suppression, particularly of the white blood cells and platelets. If the counts become too low, the patient may require hospitalization and antibiotics, because lowered white blood-cell count leaves the patient at risk for an overwhelming generalized systemic infection.

Follow-Up and Outlook

It is essential that, following treatment, patients undergo periodic urologic examinations. Patients who have not had a cystectomy and have received only radiation therapy will receive follow-up cystoscopies, chest x-rays, intravenous pyelograms (IVPs), and CT scans of the pelvis. Those patients who have had cystectomies will undergo CT scans for follow-up evaluation. Clinical trials are currently being done to evaluate the results of surgery, radiation therapy, and combination treatment plans. Chemotherapy has been shown to enhance the effects of radiation therapy. More trials are needed to better determine the role of chemotherapy in future treatment of this type of cancer.

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