When To Use Chemo and Radiation for Bladder Cancer
- Chemotherapy plus radiation can be a treatment for some people whose bladder cancer has spread into the muscle.
- This combination is an option for people who are too sick for surgery, or who choose not to have surgery.
- People who have this treatment will need monitoring afterward because bladder cancer can come back.
But surgery isn’t your only treatment option. Depending on your health, cancer stage, and personal preference, chemotherapy plus radiation may be an alternative or addition to surgery.
Read MoreDeciding on a Treatment
The decision of which bladder cancer treatment to have should start with a frank discussion between you and your doctor.“Our conversation typically goes something like this: ‘You’ve just been diagnosed with muscle-invasive bladder cancer. We need to figure out if this is the kind of cancer that we’re going to treat just by removing the whole bladder, or by giving you chemotherapy first and then removing the bladder, or sometimes with radiation,” Dr. Jay Shah, urologic oncologist at Stanford Medicine, tells SurvivorNet.
When Might You Get Chemo and Radiation?
Radiation uses high doses of energy to damage cancer cells and stop them from dividing. Chemotherapy does essentially the same thing. It prevents the cancer from growing and dividing, but with medicine. Doctors call the two treatments chemoradiation when you get them together.
Getting chemotherapy and radiation before surgery is called neoadjuvant chemotherapy. This combined treatment may help shrink your tumor. It might also lengthen your survival and improve your odds of being cured.
You may have no choice but to go with chemotherapy and radiation if you’re not healthy enough to undergo surgery. “In a small subset of patients, the patient is too old or too sick or has some combination of medical problems that just makes them really frail and at high risk of not doing well with the surgery,” Dr. Shah says.
The Role of Chemotherapy and Chemoradiation in the Treatment of Muscle Invasive Bladder Cancer
Sometimes, the bladder cancer treatment you have is a matter of personal choice. You may decide that you don’t want to undergo surgery because of the risks involved or because you strongly desire to preserve your native bladder. Your doctor should thoroughly explain the pros and cons of whichever treatments you are considering, so that you can make an informed decision.
What to Expect
If you’re getting chemoradiation, your medical oncologist will figure out which cocktail of chemotherapy drugs is going to work best for you. Often the types of chemo drugs doctors combine with radiation to treat bladder cancer are:
- Cisplatin
- Cisplatin plus fluorouracil (5-FU)
- Mitomycin with 5-FU
The radiation doctors usually use to treat bladder cancer is called external beam radiation therapy. “External” means that a machine focuses radiation on your body. Your radiation oncologist will figure out exactly where to aim the radiation beam to target your cancer.
Related: Benefit of External Beam Radiation: It’s Non-Invasive
Sometimes you’ll get chemotherapy first and then radiation. Or you might get the two treatments together. “The whole process takes somewhere around six to eight weeks to complete,” Dr. Shah says.
Chemoradiation Side Effects
Chemotherapy and radiation can each cause their own set of side effects. Combining these two treatments may lead to more side effects, including:
- Skin redness, blistering, and peeling in areas where you get the radiation
- Nausea and vomiting
- Diarrhea
- Tiredness
- Hair loss
- Mouth sores
- Increased risk of infection
Your doctor and nurse can give you advice and treatments for any side effects you do have.
After Treatment
Once you’ve finished chemotherapy and radiation, your urologist will do an exam of your bladder to see how your tumor has responded. “Depending on that response, the patient finishes their treatment with the radiation and chemotherapy, or goes on to have a radical cystectomy,” Dr. Theodorescu says.
The important thing to keep in mind if you get chemoradiation is that you will still have your bladder afterward, adds Dr. Shah. Because of that, your bladder will have to be monitored by periodic cystoscopy to assess for local recurrence.
You’ll need to see a urologist a couple of times a year for an exam and tests to check for signs of a recurrence. Staying vigilant can ensure that if your cancer does return, your doctor can treat it early, before it has had a chance to spread.
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