Chemotherapy for early bladder cancer
After your surgery, you may be given chemotherapy directly into your bladder to reduce the risk of the cancer coming back. This is known as intravesical chemotherapy.
Chemotherapy works by destroying cancer cells. When it is given into the bladder, the drug comes into direct contact with any cancer cells in the bladder lining.
Intravesical chemotherapy is different to chemotherapy given into a vein (intravenous), which is sometimes used to treat invasive bladder cancer.
Because it’s given into the bladder, you don’t get side effects, such as feeling sick or hair loss, that people may get with chemotherapy given into a vein. With intravesical chemotherapy, hardly any of the drug is absorbed into the blood, which means it rarely affects the rest of the body.
Having chemotherapy into the bladder
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Most people have a one-off treatment of intravesical chemotherapy after their operation to remove the cancer.
If there’s a low risk of the cancer coming back, you won’t usually need any more treatments.
If you have an intermediate (midway) risk of the cancer coming back, you’ll usually have a course of chemotherapy. This can be once a week for about six weeks.
Intermediate risk includes:
When you have chemotherapy into your bladder after surgery, you’ll be in hospital with a urinary catheter in place. The chemotherapy is usually given a few hours after surgery.
If you’ve had a lot of blood in your urine, it may be delayed until the following day. If you need more chemotherapy after this, you’ll have it in the hospital outpatient department. You can go home as soon as it’s finished. Your nurse or doctor will give you information about preparing for your treatment.
You may be asked to limit the amount of fluids you drink before having chemotherapy. Drinking too much can make your bladder feel uncomfortably full, and drinking less helps to increase the concentration of the chemotherapy drug in your bladder.
People who take water tablets (diuretics) should take them later in the day, after the treatment. Let your doctor know about any other medicines you’re taking or if you’re feeling unwell before your treatment. You won’t be given chemotherapy if you’re feeling unwell or have a urine infection.
When you’re lying down, the nurse will put a catheter into your bladder. They will then put the liquid chemotherapy drug directly into your bladder through the catheter. The drugs most commonly used are mitomycin-C, epirubicin and doxorubicin or sometimes a newer chemotherapy drug called gemcitabine.
Once the drug is in your bladder, the nurse usually removes the catheter. You’ll be asked not to pass urine for at least an hour. This can be uncomfortable but it gives the chemotherapy time to work. Sometimes the catheter is left in and clamped to keep the chemotherapy in your bladder for the hour. You can walk around during this time.
When the treatment is finished you can go to the toilet. If you have a catheter, the chemotherapy drug will be drained into a urine bag before the catheter is removed.
For six hours after treatment, you’ll need to take certain precautions to protect yourself and others from coming into contact with the chemotherapy drug.
You may be asked to:
avoid splashing urine on the toilet seat - if you’re a man, you may find it easier to pass urine sitting down
wash the skin in your genital area carefully with soap and water after you pass urine - to wipe off any of the drug that may have splashed on your skin
put the lid down after you’ve finished and flush the toilet twice
wash your hands carefully afterwards
drink at least 2-3 litres of fluid a day for at least 48 hours after each treatment to help flush it out of your bladder.
Your nurse will go over this with you.
The following side effects are due to inflammation of the bladder lining (cystitis):
needing to pass urine often
pain or stinging when you pass urine
blood in the urine.
These should settle down within a day or two. Drinking lots of fluid will ease the irritation. Taking mild painkillers will also help.
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 or cloudy, get in touch with your doctor straight away. These symptoms may mean you have a urine infection.
Protecting your partner
Men should use a condom during sex for the first 48 hours after chemotherapy. If you’re a woman having treatment, your partner should use a condom. This protects your partner from any of the drug that may be present in semen or vaginal fluid.
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.