Chemotherapy (chemo) uses strong medicines to kill cancer cells. Chemo attacks and kills cells that grow quickly, such as cancer cells. But some normal cells also grow quickly. Because of this, chemo can also harm those cells. This can cause side effects.
These are some of the ways chemo might be used to treat bladder cancer:
Before surgery, to try to shrink a big tumor so it's easier to take out. This can also help lower the chance that the cancer comes back after surgery.
After surgery or radiation, to help lower the chance that the cancer will come back. Even if all of the visible cancer is gone or the bladder has been removed, chemo can kill any cancer cells that may be left behind.
Along with radiation to help it work better
To treat very early stage (small) bladder cancers (Stage 0 and I) that are only in your bladder. (Intravesical chemo is used. It's described below.)
To treat bladder cancer that’s spread to other parts of your body far from the bladder
Your healthcare team will talk to you about the best treatment options for you. 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. It also may help to take notes on the things you talk about.
The way you get chemo depends on your stage of cancer. There are 2 main ways of chemo to treat bladder cancer:
This means the chemo is put right into your bladder. This may be done for early stage bladder cancers that are only on the inside lining of the bladder. It might be used before or after surgery that removes tumors from the bladder wall. Intravesical chemo mainly affects the cells in your bladder that are in contact with the chemo medicine. It's less likely to harm other cells in your body. This means there are fewer side effects.
You may get this type of chemo in your healthcare provider’s office or outpatient clinic. The chemo is put into your bladder through a soft, flexible tube (called a catheter). It's left in for 2 hours. It's then removed through the catheter or you urinate to pass the medicine out into a toilet.
The medicines most often used for intravesical chemo are:
The length of treatment and how often it's done varies a lot. Talk with your provider about the details of your treatment plan.
This means the chemo goes in through a vein and right into your blood (as an IV or intravenously). The medicines travel through your blood to reach your whole body. This means they can kill cancer cells that have spread outside your bladder. This type of chemo is used to treat bladder cancer that has spread beyond your bladder. It may be given along with radiation treatments.
Your healthcare provider may decide on a certain medicine or, more often, a combination of medicines. This is based on the stage of the cancer and your health history. There are many medicines that may be used for systemic chemo for bladder cancer.
When chemo is given along with radiation, the most commonly used chemo medicines are:
Cisplatin and fluorouracil (5-FU)
Mitomycin-C and 5-FU
Paclitaxel plus cisplatin
When chemo is used by itself (without radiation), a combination of medicines often works better. The combinations most often used for bladder cancer are:
Dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (called DDMVAC)
Cisplatin, methotrexate, and vinblastine (called CMV)
Gemcitabine and cisplatin
Gemcitabine and carboplatin
Carboplatin and paclitaxel
Paclitaxel and gemcitabine
Chemo is given in cycles. This help limit damage to healthy cells and kill more cancer cells. Rest periods between treatments give normal cells a chance to recover. Your healthcare provider will talk with you about your chemo plan. You might get it daily, weekly, every few weeks, or monthly. Talk with your provider about how long you'll get chemo and what you can expect during treatment.
Side effects depend on the type and dose of medicines you’re taking. They depend on the way you get the medicines (intravesical or systemic). They also depend on if you're getting radiation at the same time, which can make side effects worse. They vary a lot from person to person.
Side effects from intravesical chemo may include:
Irritation in your bladder
Burning feeling in your bladder
Having to urinate more often
An urgent need to urinate
Blood in your urine
Discomfort or pain when passing urine
Some common short-term side effects from systemic chemo include:
Nausea and vomiting
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
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 extra fluids through your IV to help prevent this. You may also be asked to drink lots of fluids before and after chemo to help wash the drugs out of your kidneys.
Most side effects get better between treatments and go away over time after treatment ends. There are often things that can be done to help control and even prevent some side effects. Tell your healthcare providers about any side effects you have. They can help you manage side effects and keep them from getting worse.
It's important to know which medicines you're taking. Write down the names of your medicines. Ask your healthcare team how they work and what side effects they might cause.
Talk with your healthcare providers about what side effects to watch for and when to call them. For instance, chemo can make it easier for you 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 appointments. It will also make it easier for you to work with your healthcare team to make a plan to manage your side effects.