Chemotherapy for bladder cancer
Chemotherapy uses anticancer, or 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:
- as well as radiation therapy after a transurethral resection, or TUR (this is called trimodal therapy because 3 treatments are given)
- to shrink a tumour before other treatments such as surgery (called neoadjuvant chemotherapy)
- to destroy cancer cells left behind after surgery and reduce the risk of the cancer recurring, or coming back (called adjuvant chemotherapy)
- to relieve pain or control the symptoms of advanced bladder cancer (called palliative chemotherapy)
Chemotherapy for bladder cancer is usually intravesical. Intravesical means the drugs are placed directly into the bladder. Chemotherapy for bladder cancer is sometimes systemic. Systemic 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, or catheter, through the urethra and into the bladder. The chemotherapy drug is given directly into the bladder through the catheter. The drug is left in the bladder for 1–2 hours to give it time to act on the cancer cells in the lining of the bladder. The treatment is repeated once a week for several weeks. Intravesical chemotherapy may be given once or several times each month for up to a year.
Intravesical chemotherapy may be given:
- as a single dose after a transurethral resection (TUR)
- to treat tumours that recur (come back) on the surface of the bladder lining if they don’t respond to immunotherapy with bacillus Calmette-Guérin (BCG)
- as adjuvant therapy over 6 weeks
- for one year as maintenance therapy (instead of BCG) for intermediate-risk tumours (for example, when there are several tumours or tumours come back and are not high grade)
- instead of immunotherapy if a person cannot cope with the side effects of BCG
- when BCG doesn’t work and the person cannot have, or doesn’t want to have, a cystectomy
The most common drugs used in intravesical chemotherapy to treat bladder cancer are:
- mitomycin (Mutamycin)
- doxorubicin (Adriamycin)
- gemcitabine (Gemzar)
Systemic chemotherapy is given through a needle or catheter (tube) into a vein (intravenous, or IV). It may be used to treat cancer that has spread to organs and structures near the bladder (called locally advanced cancer) and cancer that has spread to other parts of the body (called metastatic cancer). A combination of chemotherapy drugs is given because together they are more effective than any single drug.
The most common chemotherapy drug combinations used as systemic therapy to treat bladder cancer are:
- GemCIS or GC – gemcitabine and cisplatin (Platinol AQ)
- MVAC – methotrexate, vinblastine (Velbe), doxorubicin and cisplatin
- CMV – cisplatin, methotrexate and vinblastine
Information about specific cancer drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about chemotherapy
Seeing my sister Erin – a young mother – struggle with the emotional blow and then the physical toll of cancer treatment made me want to do something to help women feel confident.
Establishing a national caregivers strategy
The Canadian Cancer Society is actively lobbying the federal government to establish a national caregivers strategy to ensure there is more financial support for this important group of people.