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Radiation therapy after bladder tour. Treatment of cystitis after radiation therapy

Radiation for bladder cancer is also called radiotherapy, radiotherapy or radiation therapy. The idea is to use X-ray high energy rays to destroy cancer cells.

Highlight two types of radiation therapy:

External radiation uses an x-ray source located outside the patient's body;
Internal radiotherapy involves delivering a radiation source directly to the tumor.

External radiation is used to treat bladder cancer.

When is radiation used for bladder cancer?

As part of the treatment of early stage cancer after limited surgery;
As the primary treatment for early stage bladder cancer for patients who cannot undergo surgery;
As the initial treatment of advanced bladder cancer;
Palliative measure to relieve symptoms of metastatic cancer.

Planning radiation for bladder cancer

Radiation therapy is carried out for 6-7 weeks.

Before you begin irradiation, you will be given individual treatment plan. The doctor must mark the place where the X-rays will be sent, plan the number of sessions, calculate the intensity and duration of the radiation, etc. To do this you need to know exact size and location of the tumor, therefore, before irradiation, a computed tomography is performed, which allows one to obtain the necessary data.

How is irradiation carried out?

Before the session, marks are applied to the skin using permanent ink to indicate the treatment area. Marks can be retained for a long time. Sometimes marks can be applied using tattooing.

Drawing.

The radiation therapy machine is very large. X-ray source is mobile and can be fixed in any position that provides the most effective effect on the tumor. Before the session, your doctor will explain to you what you will hear and see during the procedure.

Irradiation is carried out in a special radiation therapy room. You will be alone at the time of exposure. But there is a special window in the office through which a specialist will watch you.

Drawing.

A session can last from one to several minutes. It is very important at this time not change body positions, which you took before the start of radiation. You may be asked to hold your breath or take shallow breaths.

Radiation therapy is painless. Where the rays pass on the skin redness may occur.

Irradiation doesn't make you radioactive, and you will not pose a danger to family members.

Side effects of radiation for bladder cancer

Common Side Effects

Weakness;
fatigue and fatigue;
Decreased appetite, etc.

Local side effects

Pain and redness of the skin(erythema) in the area of irradiation. As a rule, the patient is bothered by itching, which the following recommendations will help to cope with:

Wear loose clothes made from natural materials, such as cotton;
Avoid hypothermia or overheating, exposure to direct sunlight;
It is better to avoid water procedures such as swimming or medicinal baths for a while;
While taking a shower or bath, avoid using too hot or cold water, bath products or shower gels;
Don't use creams or other emollients.

The redness will subside in a few weeks. If you have questions about skin care, you can contact your doctor. In the future, this area of skin will be more susceptible to exposure to sunlight, so it is important to use a cream with a high protection factor.

Bladder side effects

After radiation, you may experience symptoms of bladder irritation, similar to a urinary tract infection:

Frequent urination;
Burning sensation during emptying of the bladder;
False urge to urinate, which makes you urgently run to the toilet;
The appearance of blood in the urine, etc.

If you have symptoms of bladder irritation, be sure to tell your doctor about this, it is necessary to exclude the existing possibility of developing a bladder infection.

These symptoms disappear two to three weeks after the end of the radiation course.

Long term(several months or years after treatment), one in five patients may experience some minor changes in bladder function. Under the influence of radiation The bladder may decrease in size and the patient may need to urinate more often. Bleeding from the bladder may also occur periodically. Rarely, radiation therapy can cause damage to the bladder, requiring surgery.

Bowel symptoms

Since the intestines are located next to the bladder, symptoms of bladder irritation may occur after treatment. The patient may be concerned about the need for more frequent bowel movements, tenesmus (false, painful urge to defecate), blood may appear in the stool. Over time, these phenomena go away on their own.

Among the long-term side effects, some patients may experience long-lasting bowel dysfunction. In rare cases, bowel damage may occur due to radiation, requiring surgical treatment.

Side effects on the female reproductive system

Radiation therapy may cause premature menopause in women. There is also the possibility of pathological narrowing of the vagina as a result of the formation of scar tissue. To prevent this, your doctor may recommend the use of vaginal dilators.

Unfortunately, in the vast majority of cases, radiation has a negative effect on the reproductive system, both men and women. In men, there is a significant deterioration in qualitative and quantitative sperm composition. In women it occurs early menopause. These changes in the reproductive system lead to infertility.

Radiation therapy is the treatment of tumors using ionizing radiation, which has a destructive effect on tumor cells. This procedure may expose the bladder to radiation. Cystitis is often a consequence of radiation therapy, and in this article we will solve this problem and find a treatment for everyone.

Why does radiation cystitis occur?

Radiation treatment of cancer cells has been used in medicine for a long time. The essence of the method is the impact of a certain type of energy on malignant cells, with their further destruction and destruction. But in addition to tumor tumors, radiation can also affect healthy cells.

Causes of radiation cystitis:

Urologist about cystitis: Do not buy expensive drugs, not all of them treat cystitis, I did research and found the most effective and cheapest remedy!

high dose of radiation;
short breaks between procedures;
violation of therapy technique;
the bladder mucosa is very sensitive to ionizing radiation;
Radiation exposure leads to a decrease in the body's protective functions, which can provoke the growth and development of pathogenic microorganisms.

Pathological changes in the walls of the bladder most often occur after radiation therapy of the pelvic organs.

What happens to the bladder during radiation cystitis

Changes in the bladder after such therapy can be either minor or extensive.

Radiation damage to the bladder:

frequent painful urination (in severe cases up to 40 times a day);
the presence of blood in the urine (microhematuria);
vascular changes in the bladder (telangiectasia);
reduction in bladder capacity;
ulcerative-necrotic changes.

Radiation damage is divided into the following types:

early (can occur during radiation therapy and within 3 months after completion);
late (occur after 3 months, most often after many years).

Treatment of cystitis after radiation therapy depends on the severity of the disease and is a long process.

Treatment

Before prescribing treatment for radiation cystitis, it is necessary to undergo a thorough diagnosis. Typically, the basis of treatment is anti-inflammatory therapy, stimulation of regenerative processes, and drugs to improve general immunity.

Due to the complexity of the disease and serious pathological changes in the bladder, conservative methods of treating radiation cystitis do not always bring the desired effect.

Anti-inflammatory therapy for this disease

For inflammatory processes in the bladder caused by bacterial activity and associated infection, anti-inflammatory and antibacterial drugs are prescribed, for example, Amoxiclav (amoxicillin + clavulanic acid), Metronidazole.

At the initial stage of treatment, injections are most often prescribed. After a course of injections, you may need to take additional medications in the form of tablets.

To more effectively and quickly suppress pathogenic microorganisms, bladder instillations are performed. Instillation refers to the drip administration of medications through the urethra. The doctor selects medications individually.

In addition to antibacterial drugs, medications that stimulate reparative (restorative) processes in the bladder can be prescribed.

For acute pain, painkillers (Ketorol, Baralgin) and antispasmodics (No-shpa, Papaverine) are prescribed.

Immunostimulating therapy

To increase general immunity and maintain the body's protective functions, complex treatment is prescribed, which includes: regenerating agents; drugs to stimulate the hematopoietic system; medications to improve liver function (“Essentiale”); vitamin complexes and, if necessary, antihistamines.

To reduce bladder overactivity (involuntary urination), drugs are prescribed that help reduce the contractile activity of the organ and increase its functional capacity, for example, Detrusitol, Vesicare. Medicines are prescribed only by the attending physician.

Also, do not forget about a balanced diet, excluding foods with an irritating effect on the mucous membrane.

Phytotherapy

As an additional treatment, it is possible to use herbal remedies that have antimicrobial, diuretic and antiseptic effects. Urological preparations, a decoction of bearberry leaves, an infusion of birch buds, and lingonberry decoction are suitable.

Herbal preparations such as “”, “”, “” are used as a supplement to the main treatment. They have anti-inflammatory and antispasmodic effects.

Laser therapy

Laser therapy has a positive effect on microcirculation of the bladder. Under the influence of laser radiation, regenerative processes are stimulated, blood supply to the tissues of the diseased organ is improved, and it has a bacteriostatic effect.

Oxygenation or oxygen treatment

In severe cases, hyperbaric oxygen therapy (HBO) is used to treat radiation cystitis. The HBOT procedure involves inhaling 100% oxygen under pressure. This method improves cellular nutrition, has a healing effect and enhances the body's immune system. The procedure is carried out using a pressure chamber.

This method has some contraindications, such as claustrophobia or epilepsy, but is generally effective and safe.

Other treatments

Conservative treatment methods do not always achieve positive dynamics.

with a significant decrease in bladder volume;
serious pathological changes (ulcer, severe swelling) that impair the functioning of the organ;
obstruction of the outflow of urine due to the presence of stones in the bladder;
excessive filling of the bladder with blood due to hematuria;
deterioration of the patient's condition making diagnosis difficult.

There are various ways when conservative treatment is ineffective:

diathermocoagulation. Mainly used for ulcerative tumors in the walls of the bladder. The method involves the use of high frequency electric current, which has a destructive effect on pathological formations;
nephrostomia. It is carried out when the outflow of urine is impaired. The procedure involves creating an artificial drainage path for urine from the kidney using a drain, catheter, or stent;
surgical method for removing bladder stones;
resection of the bladder. Removal of an organ is performed extremely rarely in cases of extreme necessity, when other methods of treatment are not suitable.

After any surgical intervention, antibacterial, anti-inflammatory, and painkillers are prescribed.

Cystitis after radiation therapy may take many years to appear. To prevent pathological changes in the bladder, endoscopic examination and consultation with an experienced doctor are recommended.

Radiation therapy for bladder cancer is rarely used as an independent method of treatment, mainly for palliative purposes for inoperable tumors (if surgical resection is impossible or impractical for some reason).

Most often, radiotherapy is used in combination with other treatment methods - surgical resection and. Typically, radiation therapy is used for small tumors that penetrate the muscle layer of the bladder wall.

Radiation therapy in the treatment of bladder cancer can be external () and internal. To carry out external irradiation, special devices are used that direct radiation to the area where the tumor is located. Modern remote methods of radiation therapy make it possible to concentrate radiation power on the tumor and reduce the impact of radiation on surrounding healthy tissue. As a rule, external beam radiation therapy is carried out in courses of 5 days a week for 5-7 weeks. This type of treatment is carried out in large medical centers.

Internal (interstitial) irradiation is carried out using radioactive materials placed in the tumor area. Typically, radioactive material is inserted through a small incision in the lower abdomen or through the urethra. To carry out such treatment, radioactive granules, needles, wire, etc. can be used. With this method of treatment, the patient must remain in the hospital throughout the entire course, and visits to relatives are limited due to the danger of radiation. Currently, the interstitial method of radiation therapy is used in medical practice quite rarely.

Radiation therapy for bladder cancer can be used as adjuvant therapy or as neoadjuvant therapy. In the first case, radiation therapy is used as an addition to surgical treatment (after it) and is aimed at destroying cancer cells that may have remained after surgery. Thus, adjuvant therapy leads to a significant reduction in the risk of tumor recurrence.

Neoadjuvant therapy involves the use of radiotherapy before surgery. This method makes it possible to reduce the bladder tumor (which will subsequently facilitate its removal), reduces perifocal inflammation, and in some cases turns an inoperable tumor into an operable one.

In recent years, the use of high-energy sources (linear accelerators, betatrons) has become increasingly widespread in clinical practice, which opens up great opportunities in the treatment of patients with bladder cancer.

Among the complications of radiation therapy for bladder cancer, the most common are radiation dermatitis - manifestations of the skin's reaction to radiation: redness, dryness, erosion, and in some cases itching and ulcers. The intensity of the manifestations depends on the method of radiation therapy, the duration of the course of treatment, the dose received, as well as on the individual sensitivity of the patient’s skin.

In addition, there are also complications of radiation therapy, such as radiation cystitis and proctitis (inflammation of the mucous membrane of the bladder and rectum). To treat radiation cystitis, painkillers and bladder rinsing with antiseptics are prescribed. When the rectal mucosa is affected, discomfort is usually felt during defecation, and the release of mucus and blood. Treatment of proctitis is carried out using microenemas with chamomile decoction. In some cases, women may stop menstruation during irradiation, which is explained by disruption of the functioning of the ovaries due to exposure to radiation.

Late complications of radiotherapy for bladder cancer include atrophy of the bladder mucosa, ulcerative cystitis, as well as atrophy and swelling of the skin, subcutaneous tissue and pelvic organs.

In addition, irradiation can affect the bone marrow located in the pelvic bones, which can result in anemia and a decrease in white blood cells. This can cause dizziness and increased fatigue, as well as increased susceptibility to infections due to decreased immunity.

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Bladder cancer is a malignant neoplasm, one of the few that, with timely diagnosis and treatment, has a high probability of a favorable outcome.

Causes of bladder cancer

There are a number of provoking factors that can cause the formation of a bladder tumor. Among them:

Hereditary or genetic predisposition, presence of cases of tumor diseases in close relatives

Exposure to radiation, harmful chemicals

Alcohol abuse

Smoking

Chronic infectious and inflammatory diseases of the pelvic organs

Acute and chronic stress

Diabetes mellitus

Chemotherapy for other forms of cancer

According to statistics, bladder cancer is 4 times more common in men than in women.

Bladder Cancer Symptoms

The manifestations of bladder cancer are varied. In each specific case, a different combination of symptoms may be observed, including:

Pain when urinating

Pain outside of urination - in the abdomen, in the lumbar region, in the side, in the anus, in the perineum and groin

Frequent urination in small portions

The appearance of blood in the urine or, in medical terms, hematuria

The appearance of swelling in the legs

Weight loss, loss of appetite, increased fatigue, weakness

Scrotal swelling in men

Stages of development of bladder cancer

Depending on the spread of the pathological process in the bladder, several successive stages can be distinguished, which largely determine the prognosis of the effectiveness of treatment and recovery.

At this stage, cancer cells are detected in the bladder, however, without involving the walls of the organ in the pathological process.

Oncologists conditionally divide the zero stage into two periods:

0a - is a non-invasive papillary carcinoma growing towards the lumen of the bladder, without growing to the walls of the organ and without involving lymph nodes in the pathological process

0is - the tumor does not grow in the lumen of the bladder and beyond its wall. Just like in the previous stage, cancer does not affect the lymph nodes

High-quality comprehensive treatment at this stage allows you to achieve complete recovery in almost 100% of cases.

At this stage, the cancer tumor moves further into the wall of the bladder, but does not affect its muscle layer. With timely and adequate treatment, the prognosis of the disease is very favorable; complete recovery can be achieved in almost 100% of cases.

At this stage, the spread of the tumor process moves to the muscle layer of the affected organ, but without complete germination into it. There is no spread to nearby lymph nodes. With timely and adequate therapy, the chances of cure are about 63-83%.

Stage III

The third stage of bladder cancer is when the tumor has already grown through the wall of the organ. In this case, the next stage is the spread of the pathological process further - in men to the prostate and testicles, in women - to the vagina.

An important point is that the lymph nodes are not affected at this stage of the disease.

With timely, comprehensive and adequate therapy, the probability of complete recovery ranges from 20 to 50%.

At this stage, lymph nodes and other organs are involved in the pathological process (due to the spread of metastases).

The prognosis for the patient is extremely unfavorable; cure is almost impossible. The five-year survival rate is also very low and amounts to no more than 20%.

Diagnosis of bladder cancer

Bladder cancer in the early stages has a very favorable prognosis, responds well to therapy and can be completely cured. Therefore, it is important to undergo a full examination on time and, if the diagnosis is confirmed, to begin comprehensive treatment as soon as possible.

Among the methods for diagnosing bladder cancer, the most informative are:

Urinalysis - at the initial stage of the examination, the simplest but most informative general and cytological urine tests are prescribed

Cystoscopy is an examination of the bladder from the inside using a special device - a cystoscope, inserted through the urethra. The device is equipped with a camera that displays an image of the bladder on a computer screen for detailed examination by the doctor. During the study, you can perform a biopsy: capture a piece of suspicious tissue and send it for histology - a study that reveals the nature of the formation and confirms the diagnosis.

Computed tomography and magnetic resonance imaging, allowing you to take numerous pictures of the bladder from different angles with sections of any thickness. This is necessary to detect even the smallest tumor.

Ultrasound of the pelvic organs.

X-ray examination of the bladder using contrast agents allows you to visualize the tumor in the image.

Bladder cancer treatment

Comprehensive treatment for bladder cancer includes radiation and chemotherapy, as well as surgery. The choice of a combination of techniques is carried out individually for each patient and depends on the stage of cancer development, the age and condition of the patient and a number of other factors. Experienced oncologists analyze examination data, select the optimal treatment regimen and, if necessary, adjust it, taking into account the patient’s body’s response to the treatment.

Radiation therapy

Radiation therapy involves exposing a bladder tumor to beams of rays or high-energy particles to destroy cancer cells and slow their growth and development.

External or internal radiation therapy, or a combination of both, can be used in the treatment of bladder cancer.

In internal radiation therapy, a radioactive substance is placed in special devices directly inside the patient's body, as close as possible to the tumor.

External beam radiation therapy, as the name suggests, is external irradiation.

Radiation therapy can be used as a stand-alone treatment option, and used in combination with chemotherapy and/or surgery.

The irradiation procedure is painless and does not cause discomfort to the patient. However, this treatment option is fraught with a number of side effects, including severe nausea and vomiting, dizziness and headache, hair loss up to complete baldness.

Symptoms disappear on their own after completion of the course of treatment. During therapy, in order to improve the well-being of patients, oncologists prescribe special drugs that mitigate the severity of side effects.

Chemotherapy for bladder cancer

Chemotherapy for bladder cancer is the intravenous administration of special substances into the human body that are harmful to tumor cells. As a rule, this treatment option is not used as an independent method, but is used in preparation for surgery or to consolidate the result of surgery.

Chemotherapy is prescribed in courses, every other day or every day for 1-2 weeks. As a rule, during treatment of the disease, courses are repeated.

Side effects of bladder chemotherapy include headache and dizziness, nausea and vomiting, anemia and diarrhea, bleeding and hair loss.

Surgical treatment of bladder cancer

Surgical treatment of bladder cancer has proven to be an effective method, making it widespread throughout the world.

However, this therapy option is not suitable for every patient. Contraindications to surgical intervention are tumor growth beyond the bladder, metastases to neighboring organs, as well as conditions that prevent anesthesia.

There are several options for performing surgeries for bladder cancer:

Transurethral surgery is performed using a special device, a cystoscope, which is inserted into the bladder through the urethra. This approach allows you to get rid of the tumor partially (followed by chemotherapy and radiation therapy) or completely.

Radical cystectomy is an abdominal operation that allows you to remove not only the bladder, but also neighboring organs into which the tumor has grown.

After removing the tumor, the surgeon creates a special artificial reservoir for storing urine, which will act as a bladder.

To consolidate the results of surgical treatment, chemotherapy is prescribed.

Prognosis for bladder cancer

In the early stages of the disease, with timely diagnosis and adequate treatment, the five-year survival rate of patients with bladder cancer is quite high and reaches 88-94%.

At a severe stage of the disease, the prognosis is unfavorable.

As an independent method of treating bladder cancer, radiation therapy is rarely used, mainly for inoperable tumors (that is, when surgery for one reason or another is inappropriate and impossible), most often for palliative purposes.

Radiation therapy is mainly used to treat small tumors that have penetrated the muscle layer of the bladder wall.

TYPES OF IRRADIATION

External irradiation.

A special device is used for this. This is called external beam radiation therapy, where radiation is directed to the area where the tumor is located. Most often, this method of radiation therapy is carried out in courses of five days a week for 5-7 weeks. This method helps reduce the impact of radiation on surrounding tissues and the radiation dose. This type of radiation therapy is carried out in special medical centers.

Internal exposure.

In this method, exposure to radiation is carried out using radioactive materials that are injected directly into the area of the cancerous tumor. Most often, such material is inserted through the urethra or through a small incision in the lower abdomen. You will have to stay in the hospital during the entire radiation procedure, and visits to family and friends are limited in order to protect them from radiation. This interstitial method of radiation therapy is currently rarely used. Most often, radioactive granules, wire, needles, etc. are used to carry out this treatment method.

However, to be more effective, radiation therapy is combined with other cancer treatments.

The radiation therapy method can be used either in the form adjuvant therapy, and in the form neoadjuvant therapy.

Adjuvant therapy- This is the use of radiation therapy as an addition to surgery, when the use of radiation is aimed at destroying possibly remaining cancer cells in the place where the tumor was.

Neoadjuvant therapy is the use of radiation therapy before surgery. This method makes it possible to somewhat reduce the size of the tumor, facilitates its removal, helps reduce perifocal inflammation, and in some cases makes an inoperable tumor operable.

Postoperative radiation therapy is indicated for insufficiently radical surgery and for the prevention of tumor recurrence.

Of the methods of radiation therapy, the most effective for bladder tumors is telegammatherapy. Recently, the use of high-energy sources (betatrons, linear accelerators) in clinical practice has opened up new opportunities in radiation treatment of patients with bladder cancer.

COMPLICATIONS OF RADIATION THERAPY

Despite the attractiveness of treating cancerous tumors with radiation, which does not require any incisions, stitches, etc., it is far from the most advanced treatment method in oncology.

The thing is that in addition to the fact that radiation affects cancer cells, it also “hits” healthy cells in the area where the tumor is located. The most sensitive to its effects are rapidly dividing and growing cells. These cells include cancer cells, but also some cells from healthy tissues, in particular epithelial cells. These cells, for example, are part of the mucous membrane of the bladder and rectum, or the skin in the bladder area.

In this case, the reaction to radiation on the skin will be similar to a sunburn: it becomes red, dry, erosions may appear, and in severe cases, ulcers and itching. These manifestations depend both on the method of radiation therapy and on the dose of radiation, the duration of the course of radiation therapy, as well as on the individual sensitivity of the patient.

In addition to radiation dermatitis (the so-called reaction of the skin to radiation), radiation cystitis and proctitis (inflammation of the mucous membrane of the bladder and rectum) also occur. When these complications occur, the bladder is usually washed with antiseptics and painkillers are prescribed.

If the rectal mucosa is affected, there may be pain during defecation, discharge of blood, and mucus. For the prevention and treatment of radiation proctitis, microenemas with chamomile decoction are prescribed.

In women, during irradiation, menstruation may sometimes stop, which can be explained by the involvement of the ovaries in the radiation irradiation zone.

Late complications of radiation therapy include:

Atrophy and indurative swelling of the skin, subcutaneous tissue and pelvic organs

Ulcerative cystitis, atrophy of the bladder mucosa, fistulas.

In addition, with external irradiation of the bladder area, radiation can also affect the bone marrow, which is located in the pelvic bones. The consequence of this may be anemia and a decrease in leukocytes in the blood, which is manifested by fatigue, dizziness and infectious complications due to a decrease in the body's defenses.

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