Chemotherapy for bladder cancer

Chemotherapy uses anticancer (cytotoxic) drugs to destroy cancer cells. It is sometimes used to treat bladder cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy is given for different reasons. You may have chemotherapy to:

• destroy cancer cells in the body
• shrink a tumour before other treatments such as surgery or radiation therapy (called neoadjuvant chemotherapy)
• destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back (recur) (called adjuvant chemotherapy)
• make cancer cells more sensitive to radiation therapy (called chemoradiation)
• relieve pain or control the symptoms of advanced bladder cancer (called palliative chemotherapy)

Chemotherapy for bladder cancer that has not grown into the muscle of the bladder wall is given as intravesical therapy, which means that the drugs are placed directly into the bladder. Chemotherapy may also be a systemic therapy given through a needle into a vein. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bladder.

During intravesical chemotherapy, the doctor passes a tube (catheter) through the urethra and into the bladder. A chemotherapy drug is given through the tube and placed directly into the bladder. The drug is left in the bladder for 1 to 2 hours to give it time to work.

Intravesical chemotherapy can be used instead of intravesical immunotherapy with bacillus Calmette-Guérin (BCG).

Intravesical chemotherapy may be used to treat non-invasive papillary carcinoma (stage 0a) and non-muscle invasive bladder cancers (stage 1) that are classified as low risk or intermediate risk. A single treatment is given right after a transurethral resection of bladder tumour (TURBT), usually within 24 hours of surgery. If the bladder cancer is classified as intermediate risk, intravesical chemotherapy is given once a week for another 6 weeks (called induction therapy). One year of intravesical therapy may be given if there is no cancer remaining after initial treatment (called maintenance therapy).

Intravesical chemotherapy may also be used to treat bladder cancer that comes back in the lining of the bladder, especially if intravesical BCG didn’t work.

Intravesical chemotherapy drugs used to treat bladder cancer are:

• mitomycin (Mutamycin) – the most common drug
• epirubicin (Pharmorubicin)
• doxorubicin (Adriamycin)
• gemcitabine (Gemzar)

The treatment is repeated once a week for several weeks. Intravesical chemotherapy may be given for up to a year.

Systemic chemotherapy is often used before or after radical cystectomy surgery. Sometimes it is given as a part of chemoradiation. It may also be used alone.

Systemic chemotherapy is used to treat bladder cancer that has:

• grown into the muscle of the bladder wall (muscle-invasive bladder cancer)
• spread to tissues and organs just outside of the bladder (locally advanced bladder cancer)
• spread to nearby lymph nodes
• spread to other parts of the body (metastatic cancer)

A combination of chemotherapy drugs is usually used to treat bladder cancer. The most common chemotherapy combinations are:

• cisplatin and gemcitabine
• carboplatin (Paraplatin, Paraplatin AQ) and gemcitabine
• MVAC – methotrexate, vinblastine, doxorubicin and cisplatin
• CMV – cisplatin, methotrexate and vinblastine

The chemotherapy drugs used for chemoradiation include:

• cisplatin
• mitomycin and 5-fluorouracil (Adrucil, 5-FU)
• gemcitabine

If bladder cancer does not respond to drugs used in earlier treatments or if it comes back, other chemotherapy drugs that may be used include:

• docetaxel (Taxotere)
• paclitaxel (Taxol)

Systemic chemotherapy for bladder cancer is usually given through a needle into a vein (intravenously). How often and how long chemotherapy is given depends on the type of drug used, the dose and if other treatments are used. But it is usually given every 3 or 4 weeks for up to 6 cycles.

Side effects can happen with any type of treatment for bladder cancer, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, how it’s given and your overall health.

Intravesical chemotherapy may cause an irritated or burning feeling in the bladder.

Some common side effects of systemic chemotherapy drugs used for bladder cancer are:

• nausea and vomiting
• loss of appetite
• fatigue
• infection
• hair loss
• diarrhea
• sore mouth and throat
• nerve damage (peripheral neuropathy) that can cause pain, burning or tingling in the hands and feet

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Find out more about chemotherapy and side effects of chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.