Chemotherapy for early bladder cancer

Chemotherapy works by destroying cancer cells. When it’s given into the bladder, the drug comes into direct contact with any cancer cells in the lining of the bladder. Because it’s given into the bladder and not through a vein into the bloodstream, you won’t get side effects like feeling sick or hair loss, which people often associate with chemotherapy. Hardly any of the drug is absorbed into the bloodstream which means that it rarely affects the rest of the body.

When it’s used Back to top

Most people with early bladder cancer will have a one-off treatment of chemotherapy into the bladder. This is usually given a few hours after your operation to remove the bladder cancer. Some people only have one treatment while others have a course of treatment. People with low-grade early bladder cancer won’t usually need any further treatment.

If you have a moderate risk of your cancer coming back in the bladder, you’ll usually have a course of chemotherapy into the bladder. This can include people who have:

• low-grade or intermediate-grade Ta (see our information on staging of bladder cancer) cancer when there are several cancers in the bladder or one cancer which is larger than 3cm/1in
• intermediate-grade T1 cancers when the cancer is smaller than 3cm/1in and there is only one cancer in the bladder
• low-grade or intermediate-grade Ta cancers which have come back (recurred) in the bladder.

Treatment is usually given once a week for about six weeks.

Before your treatment Back to top

You’re usually asked to limit the amount of fluids you drink before treatment, as if you drink too much your bladder may feel uncomfortably full. Drinking less also helps to increase the concentration of the chemotherapy drug in your bladder. If you normally take water tablets (diuretics), take them later in the day after your treatment. Let your doctor know about any other medicines you are taking. You won’t be given chemotherapy if you’re unwell or have a urine infection. Your nurse or doctor will give you more advice about preparing for your treatment.

How it’s given Back to top

If you’re having chemotherapy into your bladder after surgery, you’ll already be in hospital and will have a catheter (small tube into your bladder) in place. The treatment is usually given a few hours after the surgery. It may be delayed until the following day if you have a lot of blood in your urine.

If you then have more chemotherapy after this, you’ll have it in the hospital outpatient department. You can go home as soon as the treatment is finished. It might be a good idea to ask someone to collect you, particularly after the first treatment.

Your doctor or nurse will put a fine tube called a catheter into your bladder. They’ll then put the liquid chemotherapy drug directly into your bladder through the catheter. The drugs most commonly used are mitomycin-C and epirubicin. The catheter is then usually removed.

Usually you’ll be asked to try not to pass urine for at least an hour after the drug has been put into your bladder. This can be difficult but the aim is to give the treatment time to work. Sometimes the catheter is left in and clamped to keep the chemotherapy in your bladder until your treatment is over. You can walk around during this time. When the treatment is finished you can go to the toilet or, if you have a catheter, the chemotherapy drug will be drained into a urine bag before the catheter is removed.

After treatment Back to top

After treatment you’ll need to take some precautions to protect yourself and others from coming into contact with the chemotherapy drug. To avoid splashing urine on the toilet seat it might be easier for men to pass urine sitting down. You’ll be asked to wash the skin in your genital area carefully with soap and water after you pass urine. This is to make sure any of the chemotherapy drug that may have splashed onto your skin is then wiped off. It’s also important to wash your hands afterwards. Your nurse or doctor will advise you about this.

Side effects Back to top

The following side effects are due to cystitis, an inflammation of the bladder lining:

• needing to pass urine often
• soreness or pain when you pass urine.

These side effects should settle down within a day or two. Drinking lots of fluids will help ease the irritation. You might find it helpful to take mild painkillers. Occasionally some people get a red rash on their hands and feet. Let your nurse or doctor know if this happens. If the side effects don’t improve or if you have a raised temperature and your urine is smelly, get in touch with your doctor straight away as you may have a urine infection.

Contraception Back to top

It isn’t advisable to become pregnant or father a child while having chemotherapy drugs to treat bladder cancer, as they may harm the developing baby. It’s important to use effective contraception during your treatment. You can discuss this with your doctor or specialist nurse.

Men should use a condom during sex for the first 48 hours after chemotherapy and women having treatment should ask their partner to use a condom. This will protect them from any of the drug that may be present in semen or vaginal fluid