Chemotherapy for invasive bladder cancer

 

When it is given Back to top

Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. If the cancer has spread into the muscle of the bladder, or to other parts of the body, the chemotherapy drugs are given intravenously (into the vein). This is done so that they can circulate in the bloodstream and reach the cancer cells anywhere in the body.

In bladder cancer chemotherapy may be given:

• Before surgery or radiotherapy to shrink the cancer and reduce the risk of it coming back (called neo-adjuvant chemotherapy).
• At the same time as treatment with radiotherapy (chemoradiation) to make treatment more effective.
• After surgery (adjuvant chemotherapy). This is usually given if there’s a high risk of the cancer coming back. This is being researched in clinical trials because we still don’t know how effective it is.
• As a treatment on its own for advanced bladder cancer.

A combination of different drugs are 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 most commonly used to treat bladder cancer are cisplatin, carboplatin, methotrexate, vinblastine, gemcitabine (Gemzar®) and doxorubicin.

A combination of the drugs methotrexate, vinblastine, doxorubicin and cisplatin (called MVAC for short) is often used to treat bladder cancer. Other common combinations are cisplatin|, carboplatin|, methotrexate|, vinblastine|, gemcitabine (Gemzar®)| and doxorubicin|.

Side effects Back to top

Chemotherapy drugs can cause side effects, but these can usually be well controlled with medicines.

Lowered resistance to infection Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection|. Contact your doctor or the hospital straight away if:

• Your temperature goes above 38ºC (100.5ºF).
• 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. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, or blood spots or rashes on the skin.

Anaemia (low number of red blood cells) You may become anaemic. This can make you feel tired and breathless|.

Feeling sick (nausea) and being sick (vomiting) Your doctor can prescribe very effective anti sickness drugs (anti-emetics) to prevent or reduce this. Our information on controlling nausea and vomiting| may be useful.

Sore mouth Some chemotherapy drugs can make your mouth sore| and may cause small ulcers. Your nurse will show you how to look after your mouth and give you special mouthwashes to take regularly.

Poor appetite If you don’t feel like eating during treatment, you can try replacing some meals with nutritious drinks or a soft diet. Our section on eating well| has some useful tips on coping with eating problems.

Hair loss Some chemotherapy drugs may make your hair fall out. If you lose your hair| there are many ways of covering up, including wigs, hats or scarves. You may be entitled to a free 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 of the end of treatment.

Feeling tired Many people feel tired| during chemotherapy, particularly towards the end of treatment. This is a common side effect and it’s important to get as much rest as you need.

Although they may be hard to deal with at the time, these side effects will gradually disappear after your treatment is over.

Early menopause Chemotherapy may make some women have an early menopause. But bladder cancer is rare under 50 so you may already have had your menopause or be going through it.

Your doctor will advise you on how menopausal symptoms, which can include hot flushes and vaginal dryness, can be treated.

Contraception
It is 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 foetus. 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.