Bladder cancer

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Side effects of chemotherapy for bladder cancer

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. Side effects can develop 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 or drug combination given
  • the dose
  • how the drug is given (intravesical or systemic chemotherapy)
  • your overall health

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

Bladder problems

The following bladder problems may develop after intravesical chemotherapy:

  • burning or pain during urination
  • blood in the urine (called hematuria)
  • bladder spasms
  • need to urinate often (called urinary frequency)

It is important to drink plenty of fluids and empty the bladder often on the days that treatment is given.

Sore mouth

A sore mouth is also called stomatitis or oral mucositis. It occurs because of chemotherapy’s effect on cells inside the mouth. Painful mouth sores, ulcers in the mouth and mouth infections can also develop.

Many drugs can cause a sore mouth. It occurs more often when higher doses of drugs are used. A sore mouth occurs about a week (5–14 days) after chemotherapy starts. It often improves on its own a few weeks after treatment is finished.

Thorough, regular mouth care can help prevent a sore mouth and reduce infection. The healthcare team will give instructions on how often to clean and rinse the mouth and what to use. Pain medicines or special oral solutions may be needed to relieve pain.

Find out more about sore mouth and mouth care.

Nausea and vomiting

Not all chemotherapy drugs cause nausea and vomiting. Individual drugs vary in their effects, but nausea and vomiting are more likely when combinations of chemotherapy drugs are given.

Nausea and vomiting can occur a few hours after chemotherapy drugs are given and usually last about 24 hours. Sometimes you may have delayed nausea and vomiting a few days after treatment. Some people may have anticipatory nausea after having a few treatments, where they feel nauseated even before treatment is given because they expect to be sick.

Find out more about nausea and vomiting.

Loss of appetite

Nausea and vomiting, fatigue or a buildup of waste products as cancer cells die can cause loss of appetite. Some chemotherapy drugs can cause temporary changes in taste and smell, which can make foods seem less appetizing. Some people lose interest in food completely and don’t eat even though they know they need to. This can lead to weight loss and malnutrition.

Maintaining good nutrition during and after chemotherapy is important to help a person recover from treatment. Talk to your healthcare team or dietitian about how you can maintain good nutrition if you lose your appetite.

Find out more about loss of appetite and taste changes.


Diarrhea is an increase in the number and looseness of stools. It occurs because chemotherapy drugs often affect the cells that line the gastrointestinal (GI) tract. Many factors increase the risk of diarrhea, including the type and dose of chemotherapy drug used. Diarrhea is often worse when combinations of drugs are given. Diarrhea occurs soon after chemotherapy starts and can continue for up to 2 weeks after treatment has ended.

Find out more about diarrhea.


Constipation occurs when stools become hard, dry and difficult to pass. Many factors increase the risk of constipation, including the type of chemotherapy drug used, medicines given with chemotherapy to relieve nausea and vomiting, and lowered fluid intake. Constipation usually occurs 3–7 days after the chemotherapy drug is given.

Find out more about constipation.


Fatigue makes you feel more tired than usual and can interfere with daily activities and sleep. It occurs for a variety of reasons. Fatigue may be caused by anemia, specific drugs, poor appetite or depression. It may also be related to toxic substances that are made when cancer cells break down and die.

Fatigue can occur days after a chemotherapy treatment cycle. It may get better as time goes by. Fatigue can continue long after the person has finished cancer treatment.

Find out more about fatigue.

Hair loss

Hair loss, or alopecia, is a common side effect of many, but not all, chemotherapy drugs. Hair follicle cells are vulnerable to chemotherapy drugs because they grow fast. Hair loss can occur on all parts of the body, including the face and scalp. Hair loss can begin a few days or 2–3 weeks after chemotherapy starts. Hair usually grows back once chemotherapy treatments are over.

Hair loss is different for everyone. It is impossible to predict how much hair you will lose and how long it will last because it depends on the type and dose of drugs used and on personal factors.

The healthcare team usually recommends that you don’t perm, chemically straighten or colour your hair during treatment. It is best to wait until new hair growth becomes established and hair returns to its original state. This may take as long as 6 months or more after treatment. Talk to the healthcare team about when it is okay to use these products again.

Find out more about hair loss.

Skin changes or irritation

Some chemotherapy drugs can cause minor skin changes or skin irritation. Skin changes can occur during and for some time after chemotherapy.

A rash or irritation can occur if intravesical chemotherapy drugs come in contact with the skin. It is important to prevent urine from contacting the skin after intravesical chemotherapy. For at least 8 hours after treatment, wash your hands each time after you use the toilet and wash your genital area with soap and water after urinating.

Skin may be more sensitive to the sun or easily irritated by the sun during chemotherapy treatment.

Find out more about skin problems.

Pain at the injection site

Many chemotherapy drugs are given by injection, often intravenously. After the first needle stick to place the intravenous (IV) needle or catheter (tube) into a vein, there is usually no discomfort or pain when IV chemotherapy drugs are given.

Sometimes chemotherapy drugs can escape from the vein and leak into the surrounding tissues. This is called extravasation. Some drugs can be very irritating if they get into the tissues. These drugs are referred to as vesicants. They can cause redness, swelling, pain, burning or stinging at the injection site. In some cases, vesicants can cause severe damage to the skin and surrounding soft tissue.

Inflammation of the vein

An intravenous (IV) needle or catheter (tube) can make the vein inflamed (swollen and painful), which is called phlebitis. The area around the insertion site or along the vein can become red, warm, tender, painful and swollen while the device is in place. The chance of developing phlebitis depends on:

  • how long the IV needle or catheter is in place
  • the type of drug or solution being infused
  • the size and location of the needle or catheter

Nurses often check IV sites for signs of phlebitis. IV sites are changed regularly according to hospital or clinic practice. If phlebitis occurs, the IV needle or catheter is usually removed and started in another site. Warm, moist compresses are used to decrease inflammation. This usually helps relieve the inflammation within a few days.

Allergic reactions

Allergic reactions are not a common side effect of chemotherapy, but they can happen. Allergic reactions are most likely to occur when drugs are given intravenously and usually happen shortly after the drug is given. Although any drug can cause an allergic reaction, some chemotherapy drugs are more likely than others to cause allergic or hypersensitivity reactions.

Signs of an allergic reaction can include:

  • difficulty breathing
  • wheezing
  • coughing
  • skin rash or hives

A severe allergic reaction (called anaphylaxis) may also occur. The healthcare team closely monitors people for allergic reactions, especially when drugs are first given. Medicines and other treatments (such as oxygen therapy) are given if a severe allergic reaction occurs.

Find out more about allergic reactions with chemotherapy.

Bone marrow suppression

Bone marrow suppression is a condition in which one or more of the main types of blood cells are lower than normal.

  • A low white blood cell count is called neutropenia or leukopenia. It increases the risk for infection.
  • A low platelet count is called thrombocytopenia. It increases the risk for bruising and bleeding.
  • A low red blood cell count is called anemia. It causes fatigue, paleness and a general feeling of discomfort or illness (called malaise).

Low blood cell counts occur because of chemotherapy’s effect on the bone marrow, where blood cells are made. Blood cell counts often reach their lowest level 7–14 days after chemotherapy.

Bone marrow suppression is the most common and most serious side effect of chemotherapy. When it happens, the dose of chemotherapy drugs is adjusted right away or chemotherapy may have to be stopped temporarily.

Find out more about bone marrow suppression.

Organ damage

Certain chemotherapy drugs can cause organ damage. The healthcare team takes steps to limit the damage to healthy cells, but occasionally organ damage can occur. Whether or not organ damage occurs depends on many factors. Some of the organs that may be affected by chemotherapy include the heart, kidneys, reproductive organs and the nervous system.

Find out more about:

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

gastrointestinal (GI)

Referring to or having to do with the digestive organs.

The gastrointestinal (GI) tract, or digestive tract, includes the mouth, pharynx (throat), esophagus, stomach, small intestine and large intestine.


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