Chemotherapy into the bladder

Chemotherapy into the bladder is a treatment for non muscle invasive bladder cancer. Chemotherapy is an anti cancer (cytotoxic) drug which destroys cancer cells. You have it through a flexible tube called a catheter, which goes into your bladder.

Your doctor might call this treatment intravesical chemotherapy. Intravesical chemotherapy reduces the chance of the cancer coming back or spreading.

Intravesical chemotherapy is different to chemotherapy treatment for muscle invasive bladder cancer. Muscle invasive means the cancer has spread into or through the muscle layer of the bladder.

When do you have it

Your treatment plan depends on your risk of the bladder cancer spreading or coming back after treatment. Your doctor will tell you whether you have:

low risk non muscle invasive bladder cancer
intermediate risk non muscle invasive bladder cancer
high risk non muscle invasive bladder cancer

Single dose

You can have chemotherapy into your bladder as a one off treatment (single dose). You have it after a trans urethral resection of your bladder tumour (TURBT). For low risk non muscle invasive bladder cancer, this is often all the treatment you need.

Course of chemotherapy

If you have a moderate (intermediate) risk of your cancer coming back, you have a course of treatment. You have chemotherapy into your bladder once a week for 6 weeks.

You might also have this treatment if your cancer comes back after the initial surgery and chemotherapy treatment.

What happens

Where you have chemotherapy

After surgery, you have the chemotherapy in the operating theatre. Or you have it when you return to the ward.

For a course of chemotherapy, you usually have treatment at the cancer day clinic.

Before you start a course of chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Before each treatment you need to stop drinking fluids. This stops the urine from diluting the drug in your bladder and will help you hold the urine more easily. Your hospital will tell you when to stop drinking.

How you have chemotherapy into the bladder

You have the chemotherapy through a thin tube (catheter). This goes into your bladder through the urethra. The urethra is the tube that carries wee (urine) from the bladder out of the body.

For a single dose of chemotherapy, your doctor usually passes the catheter during the operation. So you are asleep.

If you are having a course of chemotherapy as an outpatient, the doctor or nurse puts in the catheter on the day unit.

Your doctor or specialist nurse then gives you the chemotherapy. They put a liquid chemotherapy drug into your bladder through the catheter.

Diagram showing how you have drug treatment into the bladder

Your doctor or nurse may then remove the catheter. Or they might leave it in and clamp it.

If they remove the catheter you have to try not to pass any urine for the next 1 to 2 hours. This gives the chemotherapy drugs time to be in contact with the lining of the bladder. Some hospitals may ask you to change position every now and again. This is to make sure the drug reaches all parts of your bladder lining.

You then pass urine naturally to get rid of the chemotherapy drug. Or your nurse may drain it out through a catheter.

Some hospitals allow you to go home with the medicine in your bladder. For example, if you live close by and are okay with the treatment. Your team will let you know if you can do this.

Types of chemotherapy

There are different types of chemotherapy drugs. For intravesical chemotherapy, the most common drug is mitomycin C.

Sometimes, doctors might use other chemotherapy drugs such as epirubicin or doxorubicin.

When you go home

Having bladder cancer and its treatment can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

You’ll be told you need to drink lots of fluid (2-3 litres) after this treatment. It helps clear your system of chemotherapy.

You have to be careful when you pass urine so that you don't get it on your skin. Men should sit down to pass urine, to reduce the chance of splashing. The urine contains some chemicals from the chemotherapy which could irritate your skin.

If you use the toilet then you must wash your genitals and hands immediately with warm soapy water to prevent the chemotherapy from irritating your skin.

Side effects

You get fewer side effects having chemotherapy into your bladder than you would having chemotherapy into a vein. This is because the drug tends to stay in your bladder. So very little of it gets into your bloodstream.

Some of the side effects might include:

Irritation of the bladder

Chemotherapy can irritate your bladder. You may feel as if you have a bad urine infection (cystitis). This can make you :

pass urine very often
pass urine with urgency
feel uncomfortable
feel some pain

Blood in your urine

You may have a small amount of bleeding. Contact the hospital immediately if:

the bleeding is getting worse
there are blood clots in your urine
you have severe pain when passing urine
you can't pass urine and have severe pain

Skin rash and itching

You may get a rash on your hands or feet for a short time after having this treatment. Some skin rashes may get red, sore and swollen. Some people get severe itching. Contact your doctor if you get any of these symptoms.

Infection

Some chemotherapies can increase your risk of getting an infection. You're also at increased risk of infection from having a catheter put in. If you generally feel unwell, severe pain, bad smelling urine or discharge or have a temperature contact your doctor.

Allergic reaction

There is a risk of having an allergic reaction to the chemotherapy. But this is rare. If it does happen the nurse gives you medicines to control the reaction. Tell the doctor or nurse if you feel unwell at any time.