Bladder Cancer: Chemotherapy

What is chemotherapy?

Chemotherapy (chemo) uses anticancer medicines to kill cancer cells. The medicines are made to attack and kill cancer cells that grow quickly. Some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.

When might chemo be used for bladder cancer?

Chemo might be used for bladder cancer in these situations:

• Before surgery to try to shrink a large tumor so that it can be more easily removed by surgery.

• After surgery to lower the chance that the cancer will come back. Your healthcare provider may recommend this as a safety measure even if he or she thinks all of the visible cancer is gone.

• With radiation to help it work better and help kill cancer cells that may have spread to other places in your body.

• To treat very early stage bladder cancers (Stage 0 and I) that are only in your bladder.

• After surgery to treat stage 0 or stage I bladder cancer with multiple or recurrent tumors. This is done to help prevent or delay cancers from coming back.

• To treat bladder cancer that’s spread to other parts of your body.

Your healthcare team will talk to you about the best options for treating your cancer. To help deal with the information and remember all of your questions, it helps to bring a family member or close friend with you to checkups. Bringing a written list of your concerns will also make it easier for you to remember your questions.

How is chemo given for bladder cancer?

The way you get chemo depends on your stage of cancer. There are 2 main ways of giving these medicines to treat bladder cancer:

• Intravesically. This means it’s given directly into your bladder. This may be used for early stage bladder cancers. With this approach, the medicines mainly affect only cancer cells in the bladder. The medicines are less likely to harm other cells in your body than they would be if they were put into your bloodstream. This means there are often fewer side effects.

• Systemically. This means the medicines are given into your blood intravenously (IV), as pills, or as shots. The medicines get into your blood and go through your whole body. This means they may be able to kill cancer cells that have spread outside your bladder. This type of chemo may be given with radiation treatments.

Intravesical chemo

You may receive this type of chemo in your healthcare provider’s office or outpatient clinic. Treatment is often done once a week for about six weeks. The medicine is put into your bladder through a soft, flexible tube (catheter) that’s been put in through your urethra. The medicine is left in place for several hours and then removed through the catheter. The catheter is then taken out. Sometimes the medicine is put in through the catheter and then the catheter is taken out. You’ll need to keep the medicine in for 2 hours. You cannot urinate during this time. After 2 hours, you’ll pass the medicine out with your urine. The medicines often used are:

• Mitomycin. This is sometimes combined with heating the inside of your bladder.

• Gemcitabine

• Thiotepa

• Valrubicin

• Docetaxel

Systemic chemo

There are other medicines that may be used for systemic chemo for bladder cancer. These include bleomycin, cyclophosphamide, ifosfamide, methotrexate, and pemetrexed. Your healthcare provider may decide on a certain medicine based on the characteristics of your tumor and your health history.

When chemo is given along with radiation, the most common medicines used include:

• Cisplatin

• Cisplatin plus fluorouracil (5-FU)

• Mitomycin-C with 5-FU

• Paclitaxel plus cisplatin

• Gemcitabine alone or in combination with other medicines

When chemo is used by itself (without radiation), a combination of medicines is often used to make it more effective. The combinations used most often for bladder cancer are:

• Dose-dense Methotrexate, vinblastine, doxorubicin, and cisplatin (called DDM-VAC)

• Cisplatin, methotrexate, and vinblastine (called CMV)

• Gemcitabine and cisplatin

• Gemcitabine and carboplatin

• Carboplatin and paclitazel

• Paclitaxel or docetaxel

Chemo is given in cycles. This reduces harm to healthy cells. Rest periods in between treatment give normal cells a chance to recover. Your healthcare provider will decide if you need to get chemo daily, weekly, every few weeks, or monthly. Your treatment will usually last 3 to 6 months.

What are common side effects of chemo?

Side effects are common with chemo, but it's important to know that they can often be prevented or controlled. The side effects from chemo often go away over time after the treatment ends.

Side effects depend on the type and amount of medicines you’re taking. They also depend on the way you receive the medicines (intravesical or systemic). They vary from person to person.

The side effects from intravesical chemo may include:

• Burning feeling and irritation in your bladder

• Having to urinate more often

• An urgent need to urinate

• Blood in your urine

• Discomfort or pain when passing urine

• Skin rash

Some common temporary side effects from systemic chemo include:

• Nausea and vomiting

• Mouth sores

• Constipation or diarrhea

• Hair loss

• Infections from low white blood cell counts

• Easy bruising or bleeding from low blood platelets

• Tiredness from low red blood cell counts

• Loss of appetite

• Dizziness

• Skin problems, such as dryness, rash, blistering, or darkening skin

• Tingling, numbness, or swelling in your hands or feet

Some medicines used to treat bladder cancer may cause kidney damage. Your healthcare provider may give you fluids through a vein during the procedure to prevent this. He or she may also tell you to drink lots of fluids before and after the treatments to help wash the medicines out of your body.

Most of side effects will go away or get better between treatments and over time after treatment ends. You may also be able to help control some of these side effects. Tell your healthcare providers about any side effects you have. They can help you cope with the side effects.

Working with your healthcare provider

It's important to know which medicines you're taking. Write your medicines down, and ask your healthcare team how they work and what side effects they might have.

Talk with your healthcare providers about what signs to look for and when to call them. For example, chemo can make you more likely to get infections. Make sure you know what number to call with questions. Is there a different number for evenings and weekends?

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.