Intravesical chemotherapy for bladder cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Intravesical chemotherapy is when the treatment is given directly into the bladder.

What is intravesical chemotherapy?

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. Cytotoxic means toxic to cells. These drugs disrupt the way cancer cells grow and divide.

Chemotherapy can be given directly into the bladder. This is called intravesical chemotherapy. You may have this as part of your treatment for non-muscle-invasive bladder cancer.

When is intravesical chemotherapy used?

You usually have intravesical chemotherapy after surgery to remove a non-muscle-invasive bladder cancer. This type of surgery is called a transurethral resection of a bladder tumour (TURBT). The chemotherapy reduces the risk of the cancer coming back in the bladder lining.

Most people have 1 treatment of intravesical chemotherapy after surgery. If you have a low risk of the cancer coming back, you usually do not need chemotherapy after this.

If you have an intermediate risk of the cancer coming back, you may have more intravesical chemotherapy. This is usually given once a week for 6 weeks. After this, you may be offered more intravesical chemotherapy. These are called maintenance doses.

Having intravesical chemotherapy

Chemotherapy into the bladder is given through a tube called a urinary catheter. This tube goes through your urethra and into your bladder.

The chemotherapy drug used most is mitomycin-C . Sometimes, other chemotherapy drugs may be used, such as gemcitabine or epirubicin.

After surgery

After surgery to remove a bladder tumour, you will usually have a catheter draining urine from your bladder into a collecting bag. Your nurse will give the chemotherapy through this tube.

This may happen when you are still in the operating theatre or recovery room. Or you may have it when you go back to the ward.

Your doctor may decide to delay the chemotherapy if you have a lot of blood in your urine, or if there has been any injury to your bladder during surgery.

As an outpatient

If you are having a course of intravesical chemotherapy, you have it in the hospital outpatient department. Your nurse or doctor will give you advice on preparing for your chemotherapy. For example, they will ask you to limit the amount of fluids you drink directly before chemotherapy. This can:

  • make it easier for you to keep the chemotherapy in your bladder for the required time (stops you needing to pass urine (pee) too early)
  • increase the concentration of the chemotherapy drug in your bladder.

People who take water tablets (diuretics) should take them after the treatment. Tell your doctor if you take any medications.

You will not be given chemotherapy if you are feeling unwell or have a urine infection. Your nurse will check a sample of your urine for infection at every appointment.

Before you have the chemotherapy, you are asked to lie down on a couch. A nurse passes a tube (catheter) through your urethra and into your bladder. The nurse then slowly puts the chemotherapy directly into your bladder through the catheter.

During treatment

Once the drug is in your bladder, the nurse usually takes the catheter out. They ask you not to pass urine for around one hour. This gives the chemotherapy time to work.

You can get up and walk around while waiting for the treatment to finish. Your bladder may feel full and a bit uncomfortable. You can go to the toilet as soon as the treatment is finished.

Sometimes, the nurse leaves the catheter in and clamps it to keep the chemotherapy in your bladder. When the treatment is over, the nurse removes the clamp and the chemotherapy drug drains from your bladder into a urine bag. Your nurse can then take the catheter out.

After treatment

The nurse will ask you to take certain precautions for 6 hours after treatment. This will protect you and others from coming into contact with the chemotherapy drug.

You will be asked to:

  • sit down to pass urine – this avoids splashing urine on the toilet seat
  • wash the skin in and around your genital area with soap and water after you pass urine – this cleans any drops of chemotherapy that may have splashed on to your skin
  • wash your hands carefully after passing urine using soap and water.

For about 2 days after each treatment, you will usually be asked to drink at least 2 to 3 litres (3½ to 5 pints) of fluid a day. This helps to flush the drug out of your bladder.

Talk to your nurse if you are worried. They will tell you what you need to do after treatment.

Side effects of intravesical chemotherapy

You may have some side effects after your treatment. These include:

  • needing to pass urine more often
  • pain or stinging when you pass urine
  • blood in the urine.

Most side effects are caused by inflammation of the bladder lining. This is known as cystitis. This can take up to a week to get better. Drinking fluids will help with the side effects. Try to drink 2 to 3 litres each day. Taking mild painkillers can help.

Some people may get a red rash on their skin. Tell your doctor or nurse if you get a rash on any part of your body.

Tell your doctor straight away if:

  • the side effects do not get better after 48 hours
  • you feel cold, shivery, hot or sweaty
  • your urine is smelly or cloudy.

These symptoms may mean you have a urine infection.

Rarely a person may find it difficult to pass urine or have severe tummy pain. Some people may have pain around the penis. Tell your doctor or specialist nurse straight away if you have any of these symptoms.

Sex after intravesical chemotherapy

Men should use a condom during sex for the first 48 hours after chemotherapy. If you are a woman having chemotherapy, your partner should use a condom during this time. This protects your partner from any of the drug that may be present in semen or vaginal fluid. Your doctor or specialist nurse can give you more information about this.

Your doctor will tell you not to become pregnant or make someone pregnant while having chemotherapy to treat bladder cancer. This is because the drugs may harm a developing baby. You should use effective contraception during your treatment. Your doctor or specialist nurse can give you more information about this.

We have more information about how chemotherapy may affect your sex life.