Chemotherapy for invasive and advanced bladder cancer
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It is given into a vein (intravenously). The chemotherapy drugs circulate in the bloodstream and can reach cancer cells anywhere in the body.
Chemotherapy may be given:
before surgery or radiotherapy to shrink the cancer and reduce the risk of it coming back (neo-adjuvant chemotherapy)
at the same time as treatment with radiotherapy (chemoradiation) to make treatment more effective
after surgery (adjuvant chemotherapy) if there’s a high risk of the cancer coming back - but it’s not known how effective it is, so it’s usually given as part of a clinical trial
as a treatment on its own for advanced bladder cancer.
A combination of drugs is usually given over a few days.
You will usually be given the drugs again every few weeks over a period of several months. The drugs gemcitabine and cisplatin (GC) are often used to treat bladder cancer. Other commonly used combinations are methotrexate, vinblastine, doxorubicin and cisplatin (MVAC) and cisplatin, methotrexate and vinblastine (CMV).
We have more information about individual chemotherapy drugs and different combinations of drugs.
Chemotherapy for advanced bladder cancer
Chemotherapy may be given when the cancer has spread outside the bladder to other parts of the body. This can sometimes help shrink or slow down the growth of the cancer and reduce your symptoms. The type of chemotherapy you have will depend on how advanced your cancer is and how physically well you are. You may be given a combination of chemotherapy drugs or one drug on its own.
Many people worry about having chemotherapy because of the possible side effects, but these side effects can usually be well controlled with medicines.
Making treatment decisions when you have advanced cancer can be difficult. It’s important to talk to your doctor about the advantages and disadvantages in your particular situation. Talking it over with your family and close friends may also be helpful. If you decide not to have chemotherapy, there are other medicines and ways of controlling most symptoms of the cancer. Your doctor will discuss these with you.
Chemotherapy drugs can cause side effects, but these can usually be well controlled with medicines. They include:
Risk of infection
Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. The number of your white blood cells then increases steadily and usually returns to normal within 21–28 days.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel ill, even with a normal temperature.
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (blood count) is still low.
Bruising or bleeding
Chemotherapy can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
You may become anaemic. This may make you feel tired and breathless. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Feeling sick (nausea) and being sick (vomiting)
This may begin a few hours after treatment and last for up to a day. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce this. If this sickness isn’t controlled or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Your mouth may become sore or you may notice small ulcers. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicines to prevent or clear mouth infections.
If you don’t feel like eating during treatment, you can try replacing some meals with nutritious drinks. These can be prescribed by your doctor, specialist nurse or dietitian.
We have more information about and some useful tips on coping with eating problems.
Some chemotherapy drugs may make your hair fall out. If you lose your hair there are many ways of covering up, including hats, scarves or wigs. You may be entitled to help towards the cost of a wig from the NHS. Your doctor or nurse can arrange for a wig specialist to visit you. Your hair should start to grow back again within about 3–6 months after your treatment ends.
Many people feel tired during chemotherapy, particularly towards the end of treatment. Try to balance periods of rest with gentle exercise such as walking when you feel able.
Although they may be hard to deal with at the time, the above side effects will gradually disappear after your treatment is over.
Women who haven’t been through the menopause (change of life) may experience an earlier menopause after having chemotherapy. Menopausal symptoms can include hot flushes and vaginal dryness, If you are affected by menopausal symptoms, your doctor or specialist nurse can advise you on treatments that can help.
It’s not advisable to become pregnant or father a child while taking any of the chemotherapy drugs used to treat bladder cancer, as they may harm the developing baby. It’s important to use effective contraception during your treatment and for up to a year afterwards. You can discuss this with your doctor or specialist nurse.
Condoms should be used during sex for the first 48 hours after chemotherapy. This is to protect your partner from any of the drug that may be present in semen or vaginal fluid.
We have more information about how chemotherapy might affect your sex life.