Urethral Cancer: Radiation Therapy
Radiation therapy uses high-energy particles or waves to kill cancer cells or to stop them from growing. It may be used to treat urethral cancer. Whether and how it's used depends on the type of urethral cancer and its location in your urethra.
Two types of radiation can be used in the treatment of urethral cancer: External beam radiation and brachytherapy. In external beam radiation, the energy rays come from a large machine and are focused inside of your body. They’re aimed at the tumor. In brachytherapy, or internal radiation, a radioactive material is put right into or near the tumor. Sometimes both types of radiation are used together.
Radiation alone is sometimes used as the first option to treat male urethral cancer. But it's more commonly used before or after surgery. It may be used before surgery to shrink a tumor so it's easier to remove. After surgery, it kills any cancer cells that may remain. In women, radiation alone may be an option for some early stage cancers. It’s usually given along with chemotherapy. This is called chemoradiation.
Certain chemo medicines help radiation better kill cancer cells. So chemoradiation is often used to get better outcomes when treating higher stage urethral cancers. Radiation may also be used before or after surgery for cancers that have spread to a large part of the urethra close to the bladder.
Deciding on a radiation treatment plan
You’ll work with a radiation oncologist to make your treatment plan. This is a healthcare provider who specializes in treating cancer with radiation. This provider decides:
The goal of radiation
The type of radiation you need and when you should get it, such as with or without chemotherapy or before or after surgery
The dose of radiation you need
How long you need treatment
It may help to bring a family member or friend with you to appointments. Make a list of questions and concerns you want to talk about. During your visit, ask what the goal of radiation is. Also ask what you can expect to feel during and after the treatments.
What to expect during radiation therapy
External radiation is often given once a day, 5 days a week, for a set number of weeks.
Each treatment is like getting an X-ray. The radiation comes from a large machine. The machine doesn't touch you during the treatment. The treatments are quick and don't hurt.
Before you start treatment, imaging scans will be done. They're used to see the exact location of the tumor so the beams of radiation can be focused there. Small marks of permanent ink or tiny tattoos may be put on your skin to mark the treatment area. This helps the team be sure that the radiation is focused on the tumor and limits damage to healthy parts of your body.
On the day of treatment, your healthcare provider will carefully put you into the right position. You may see lights from the machine lined up with the marks on your skin. These help the therapist know you’re in the right position. The therapist will leave the room while the machine sends radiation to your tumor. During this time, they can see you, hear you, and talk to you. When the machine sends radiation to your tumor, you’ll need to be very still, but you don't have to hold your breath. Treatment takes only a few minutes, and the whole process will likely take less than an hour.
In this treatment, your healthcare provider puts tiny radioactive seeds or pellets or radioactive wires into or near the tumor. This is often done by putting the seeds into a thin tube that's put in your urethra. The radiation the seeds give off travels a very short distance. This helps make sure it affects the cancer cells with very little effect on nearby tissue.
Brachytherapy might be used for women with tumors that are close to the outside opening of the urethra and haven't spread deeply in the wall of the urethra or the tissues around it. It's seldom used in men.
There are different ways to give brachytherapy. Talk to your radiation oncologist to find out what you can expect.
Side effects of radiation
Talk with your healthcare provider about what you might feel like during and after radiation. All cancer treatments have side effects. Side effects often get worse as treatment goes on, but they can be treated. Most side effects get better or go away over time after treatment ends.
Side effects of radiation can include:
Skin irritation. This can lead to redness, dryness, and soreness.
Burning during urination
Urinating more often or a more urgent need to urinate
Urinary incontinence (unable to control your urine)
Rectal pain and bleeding
Vaginal bleeding in women
Hair loss in only the area being treated
Narrowing of the urethra
In most cases, these side effects go away after treatment. Many side effects can be managed with medicines.
Some side effects may last a long time. These can include urethral or vaginal strictures (narrowing caused by scar tissue build up). This may require surgery or dilatation (gentle stretching to open it). Some long-term side effects of radiation may not show up until many years after treatment. These depend on the dose and type of radiation. They also depend on how many times you had treatment.
Talk with your provider about what side effects you can expect. Ask what can be done to prevent or ease them. Ask your provider what symptoms to watch out for. In some cases, you should call your healthcare team. They may want you to call if you have signs of infection, such as fever, or pain that gets worse. Be sure you know what number to call and what to do if you need help at night, on weekends, and on holidays.