What is radical radiotherapy for bladder cancer?

Radiotherapy uses high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. Radical radiotherapy means using high doses of this treatment to try to cure cancer.

This treatment is used to treat muscle-invasive and locally advanced bladder cancer. It can cause infertility in men and infertility in women. If you are worried about your fertility, talk to your doctor before your treatment starts.

How radical radiotherapy is given

Radiotherapy is given in the radiotherapy department at the hospital as a series of short, daily treatments. You may have to travel to a hospital further away than your local hospital to have this treatment. You can usually have it as an outpatient. Each treatment takes 10 to 15 minutes.

The treatments are usually given once a day from Monday to Friday, with a rest at the weekend. For bladder cancer, it usually takes 4 to 7 weeks to have a course of radical radiotherapy.

Types of radical radiotherapy

There are different ways of giving radiotherapy to treat bladder cancer.

Image guided radiotherapy (IGRT)

IGRT uses the pictures from scans taken before, and sometimes during, each treatment. These pictures show the size, shape and where the tumour is in the bladder. IGRT means the radiographers can use the pictures to adjust the treatment area before each treatment. This makes the radiotherapy very precise.

Intensity modulated radiotherapy (IMRT)

IMRT shapes the radiotherapy beams. It allows different strengths of radiotherapy to be given to different parts of the bladder. It may be used if you have large bladder tumours or if the cancer has spread to the lymph nodes in the pelvis.

Conformal radiotherapy

Conformal radiotherapy uses a device inside the radiotherapy machine to shape the radiation beams to match the shape of the cancer. This reduces the radiation received by surrounding, healthy cells.

Your radiotherapy team can tell you more about these types of radiotherapy.

We have more information about having radiotherapy.

Having other treatment with radiotherapy

You may have other treatment with radical radiotherapy to help make it work better. You may have radiotherapy with:


Chemotherapy given with radiotherapy is called chemoradiation. You may have chemotherapy every day (Monday to Friday) in the first and fourth week of your radiotherapy. Or once a week during the radiotherapy course. Chemoradiation may cause more severe side effects, so you need to be well enough to have this.

Carbogen and nicotinamide

You may have a gas called carbogen that you breathe in for a few minutes before and during your radiotherapy. You also take nicotinamide tablets. Carbogen and nicotinamide help increase the amount of oxygen that the cancer cells get. Cancer cells are more likely to be destroyed by radiotherapy if they have lots of oxygen. This treatment is not available in all hospitals. Your doctor will tell you if this is an option for you.

Side effects of radiotherapy to the bladder

Your doctor, nurse or radiographer will talk about side effects with you. Tell them about any side effects you have during or after treatment. There are often things that can be done to help. After treatment finishes, side effects usually get better over a few weeks or months.

Radiotherapy to the bladder and nearby areas can cause the following side effects.

Bowel effects

You may have diarrhoea and sore skin around the back passage (rectum).

Bladder effects

You may need to pass urine (pee) more often. You may also have a burning feeling when you pass urine.

Effects on the skin

The skin in the area being treated may become red and sore or itchy. It may also become darker.


You may feel very tired, especially towards the end of treatment. Tiredness can continue for weeks or sometimes longer after your treatment has finished.

Hair loss

You may lose some of your pubic hair. It usually grows back after treatment finishes. It may take several months to grow back, although it depends on the dose of radiotherapy you have. Sometimes, hair loss is permanent.

We have more about managing these side effects in our information about side effects of pelvic radiotherapy during treatment.

Possible late effects of radiotherapy to the bladder

Some people may have side effects that do not improve, or side effects that happen months or years after treatment. These are called long term or late effects. Your doctor or nurse will explain these to you. Late effects of radiotherapy to the bladder may include:

  • bowel or bladder changes
  • vaginal changes
  • erection problems (erectile dysfunction)
  • infertility.

There are different ways late effects can be treated or managed. We have more information about managing late effects of pelvic radiotherapy.

Getting support

Macmillan is also here to support you. If you would like to talk, you can: