Mitomycin and 5FU with radiotherapy
Mitomycin and fluorouracil (5FU) chemotherapy with radiotherapy is a treatment used for anal cancer or muscle-invasive bladder cancer.
Mitomycin and fluorouracil (5FU) with radiotherapyBack to top
This information is about a chemotherapy treatment called mitomycin and fluorouracil (5FU), when it is given with radiotherapy. When chemotherapy and radiotherapy are given together, it’s called chemoradiation. Mitomycin and fluorouracil (5FU) with radiotherapy is a treatment used for anal cancer or muscle-invasive bladder cancer. It is also sometimes used to treat other cancers, such as cancer of the penis or vulva.
This information should ideally be read with our general information about chemotherapy, radiotherapy and your type of cancer.
Sometimes mitomycin and fluorouracil (5FU) are given without radiotherapy.
There are two drugs in this treatment:
- mitomycin (Mitomycin C Kyowa®)
- fluorouracil (5FU).
In this information, we call fluorouracil by its more common name 5FU.
How chemotherapy is givenBack to top
You are usually given chemotherapy in a chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
How mitomycin and 5FU are given with radiotherapyBack to top
You start the chemotherapy and radiotherapy on the same day. Radiotherapy is then given once a day (Monday–Friday) for 4–7 weeks. The number of weeks depends on the type of cancer you have. You will have chemotherapy during the first week of your treatment, and again in week four or five.
On the first day of treatment
Your nurse gives you anti-sickness drugs as an injection into a vein or as tablets. They give you the drugs and chemotherapy through one of the following:
- A short, thin tube (cannula) that the nurse puts into a vein in your arm or hand.
- A fine tube that goes under the skin of your chest and into a vein close by (central line).
- A fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Mitomycin is a blue or purple fluid. Your nurse gives you it as an injection directly into your vein, with a drip (infusion) to flush it through. Some people might have side effects while they are having mitomycin.
Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include a rash; feeling itchy, flushed or short of breath; swelling of your face or lips; feeling dizzy; having pain in your tummy, back or chest; or feeling unwell. Tell your nurse straight away if you have any of these symptoms.
The drug leaks outside the vein
If this happens when you’re having mitomycin, it can damage the tissue around the vein. This is called extravasation. Tell the nurse straight away if you have any stinging, pain, redness or swelling around the vein. Extravasation is not common but if it happens, it’s important that it’s dealt with quickly.
If you get any of these symptoms after you get home, contact the doctor or nurse straight away on the number they gave you.
After the mitomycin, you have 5FU. This is usually given through a small pump, which is connected to your central or PICC line. You can wear this on your belt or carry it in a bag. It gives the drug slowly over 4–5 days.
Your chemotherapy nurse will explain how to look after the pump and what to do if there’s a problem.
If you have a cannula, you will need to stay in hospital while you have 5FU through a drip over 4–5 days.
After the 5FU is started, you go to the radiotherapy department to have your first radiotherapy treatment. Often, you can have radiotherapy in the same hospital and on the same day as you have chemotherapy. But you may need to have chemotherapy at one hospital, then go to a different hospital the next day to have radiotherapy.
Usually you will go home with the 5FU pump after the first radiotherapy treatment. But if you have a cannula, you will stay in hospital until the 5FU is finished. You will still have radiotherapy each day while you are in hospital.
Before you go home, the nurse or pharmacist will give you anti-sickness drugs to take. They may also give you anti-diarrhoea tablets. Take all your tablets exactly as they have explained to you.
The next days and weeks
You’ll come back to the hospital each weekday for radiotherapy for 4–7 weeks, depending on the type of cancer you have. When the 5FU pump is empty, you go to the chemotherapy day unit and the nurse will disconnect it, or a district nurse will disconnect the pump for you at home.
Week four or five of treatment
On week four or five of radiotherapy, the nurse will connect a 5FU pump to your line again for 4–5 days. You have this done at the chemotherapy day unit. Again, when the 5FU pump is empty, you go to the chemotherapy day unit and the nurse will disconnect it, or a district nurse will disconnect the pump for you at home.
Possible side effects of mitomycin and fluorouracil (5FU)Back to top
We explain the most common side effects of mitomycin and 5FU here. But we don’t include all the rare ones that are unlikely to affect you.
Radiotherapy also causes side effects. You can read about the possible side effects of radiotherapy and how to manage them in our sections:
- pelvic radiotherapy in men – managing side effects during treatment
- pelvic radiotherapy in women – managing side effects during treatment.
You may get some of the side effects we mention here, but you are very unlikely to get all of them. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these. It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means the drugs will be more likely to work better for you. Your nurse will give you advice about managing your side effects. After your treatment is over, they will start to improve.
Contact the hospital
Your nurse will give you a telephone number or numbers to call the hospital if you feel unwell or need advice at any time of the day or night. Save these numbers in your mobile phone or keep them somewhere safe.
Risk of infection
Mitomycin and 5FU can reduce the number of white blood cells in your blood. This will make you more likely to get an infection. When the number of white blood cells is low, it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – this can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
Your nurse may give you injections of a drug called GCSF under the skin. GCSF encourages the bone marrow (where blood cells are made) to make more white blood cells.
The number of white blood cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your number of white blood cells is still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
This treatment can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin. Some people may need a drip to give them extra platelets.
Anaemia (low number of red blood cells)
This treatment can reduce the number of red blood cells in your blood. These cells carry oxygen around the body. If the number of red blood cells is low, you may be tired and breathless. Tell your doctor or nurse if you feel like this.
During radiotherapy you may have blood tests once or twice every week. Having low number of red blood cells can affect how well the radiotherapy works. If your blood test shows anaemia, you may need a drip to give you extra red blood cells (blood transfusion).
This can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explained. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than three times a day, or if you ever have it at night, contact the hospital straight away on the numbers your nurse gave you.
This may happen in the first few days after chemotherapy. But sickness isn’t common with mitomycin and 5FU. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures in the morning, at night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Your hair may thin, but you’re unlikely to lose all the hair from your head. Hair loss usually starts about 3–4 weeks after starting chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after. Try to pace yourself and get as much rest as you need. It helps to balance this with taking some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
Your urine may be a blue-green colour for up to 48 hours after you’ve had your treatment. This is due to the colour of mitomycin.
Chemotherapy may affect your skin and nails. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat. Your skin may darken. It will return to its normal colour after you finish treatment.
Radiotherapy can cause a skin reaction in the area being treated. The skin may redden or get darker, and become dry, flaky and itchy. Towards the end of treatment, the skin sometimes becomes moist and sore, and there may be breaks in the skin, especially around the back passage and groin.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome and can happen with 5FU. It gets better when treatment ends. Your doctor or nurse can give you advice and prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Less common side effectsBack to top
Effects on the nervous system
Rarely, 5FU can affect the nervous system. You may feel dizzy or unsteady. You may feel anxious or restless, have problems sleeping or experience mood changes. You may feel drowsy or confused.
Tell your doctor or nurse straight away if you notice any of these symptoms. It’s important not to drive or operate machinery if you notice these side effects.
Your eyes may become watery or sore and may become more sensitive to light. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis), tell your doctor. You may need antibiotic eye drops. Rarely, 5FU may affect your vision. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.
Changes in the way the heart works
5FU can affect the way the heart works. You may have tests to see how well your heart is working before, during and sometimes after treatment.
If you have pain or tightness in your chest or feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
Effects on the lungs
Rarely, mitomycin can cause changes to the lungs. Always tell your doctor if you develop wheezing, a cough, a fever or if you feel breathless. You should also let them know if any existing breathing problems get worse. If necessary, they can arrange for you to have tests to check your lungs.
Changes in the way the kidneys and blood cells work
Mitomycin can cause a problem with your kidneys and blood cells, called haemolytic-uraemic syndrome (HUS). This is very rare and is more common with high doses of mitomycin but it can be serious. You will have blood tests during treatment to check how well your kidneys are working, and to check your levels of red blood cells and platelets. Tell your doctor if you feel tired and breathless or have any bruising or bleeding you can’t explain.
If the doctor thinks you have HUS, they will start you on treatment straight away.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about mitomycin and 5FUBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis), and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Some medicines, including ones you can buy in a shop or chemist, can interact with or be harmful when you are having chemoradiation. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the treatment may harm a developing baby. It’s important to use effective contraception during and for a few months after chemoradiation. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in semen or vaginal fluid. Women may be advised to wait a few weeks until after radiotherapy before having sex. This is to allow any inflammation and side effects to settle. Ask your doctor or nurse for advice on this, as it can vary.
Fertility in men
Chemoradiation may affect your fertility (being able to father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
We have more information about cancer treatment and fertility in men.
Fertility and period changes in women
Pelvic radiotherapy stops the ovaries producing oestrogen and progesterone and brings on the menopause. Eventually your periods will stop altogether. This means you won’t be able to get pregnant.
We have more information about cancer treatment and fertility in women.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Give them contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
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