Bladder Cancer: Chemotherapy

What is chemotherapy?

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.

When might chemo be used for bladder cancer?

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.

How is chemo given for bladder cancer?

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

• Intravesically

• Systemically

Intravesical chemo

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 about two 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:

• Mitomycin.

• Gemcitabine

• Valrubicin

• Docetaxel

• Epirubicin

The length of treatment and how often it's done varies a lot. Talk with your provider about the details of your treatment plan.

Systemic chemo

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

• Cisplatin and fluorouracil (5-FU)

• Mitomycin-C and 5-FU

• Paclitaxel plus cisplatin

• Low-dose gemcitabine

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 helps limit damage to healthy cells and kills 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.

What are common side effects of chemo?

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

• Mouth sores

• Constipation

• 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 (neuropathy)

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 medicines out of your kidneys.

Most side effects get better between treatments and go away over time after treatment ends. But some may be long lasting or permanent. 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.

Working with your healthcare provider

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.