Chemotherapy for non-invasive bladder cancer

You will usually have chemotherapy after surgery to reduce the risk of the cancer coming back. It is given into your bladder (intravesical chemotherapy).

You will usually have the chemotherapy in hospital soon after your operation. This may be while you are still in the operating theatre, but may be the day after or later. The chemo-therapy drugs are put directly into the bladder using a catheter. This means that the drugs aren’t absorbed by the blood and you won’t get some side effects.

Most people have a single treatment of chemotherapy after surgery. But you may have a further course of intravesical chemotherapy as an outpatient. Your nurse or doctor will give you more information about preparing for this.

After each treatment, you will be asked to take certain precautions. This is to protect yourself and others from coming into contact with the chemotherapy drug. Your nurse will explain what you need to do after treatment.

Chemotherapy

After surgery, you usually have chemotherapy into your bladder to reduce the risk of the cancer coming back. This is called intravesical chemotherapy.

Chemotherapy drugs work by destroying cancer cells. When you have it into the bladder, the drug comes into direct contact with any cancer cells in the bladder lining.

Hardly any of the drug is absorbed into the blood, so it rarely affects the rest of the body. This means you don’t get some side effects, such as feeling sick or hair loss.

Having chemotherapy into the bladder

Most people have a one-off treatment of intravesical chemotherapy after surgery. If you have a low risk of the cancer coming back, you won’t usually need chemotherapy after this.

If you have an intermediate risk of the cancer coming back, you may have chemotherapy once a week for about six weeks.

How it is given

When you have chemotherapy into your bladder after surgery, you will be in hospital with a urinary catheter in place. The chemotherapy is usually given soon after surgery. In some hospitals, it is given when you are still in the operating theatre or recovery room. If you’ve had a lot of blood in your urine, chemotherapy may be delayed until the following day. If your bladder has been damaged during surgery, it may be delayed for longer.

If you need more chemotherapy after this, you will have it in the hospital outpatient department. 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 as drinking too much can make your bladder feel uncomfortably full. Drinking less also 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. You won’t be given chemotherapy if you’re feeling unwell or have a urine infection. Your nurse will check a sample of your urine to make sure there is no infection.

When you are lying down, the nurse passes a tube (catheter) into your bladder. They put the liquid chemotherapy drug directly into your bladder through the catheter. The drug most often used is mitomycin-C. Sometimes a chemotherapy drug called gemcitabine is given. Rarely, epirubicin or doxorubicin are used.

Once the drug is in your bladder, the nurse usually removes the catheter. They will ask you not to pass urine for at least an hour. This can be uncomfortable, but it gives the chemotherapy time to work. You can go to the toilet when the treatment is finished.

Sometimes the nurse leaves the catheter in and clamps it to keep the chemotherapy in your bladder. You can walk around during this time. The nurse then removes the clamp. The chemotherapy drug drains into a urine bag before the nurse removes the catheter. For six hours after treatment, you need to take certain precautions. This protects you and others from coming into contact with the chemotherapy drug.

You will usually be asked to:

  • avoid splashing urine on the toilet seat – you should sit down to pass urine
  • wash the skin in your genital area carefully with soap and water after you pass urine – this removes any traces of the drug that may have splashed onto your skin
  • put the lid down after you have finished and flush the toilet twice
  • wash your hands carefully afterwards
  • drink at least two to three litres (three and a half to five pints) of fluid a day for at least 48 hours after each treatment, to help flush the drug out of your bladder.

Your nurse will explain what you need to do after treatment.