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What to Know About Chemotherapy for Bladder Cancer

You may get chemotherapy to treat bladder cancer. This is the use of anticancer drugs. The drugs kill or slow the growth of the cancer.

Your doctor may advise chemotherapy as your only treatment. Or you may have it in combination with other treatments like these:

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

  • After surgery and radiation to lower the chance that the cancer will come back. Your doctor may recommend this as a safety measure even if your doctor believes most of the cancer is gone.

Chemotherapy may be given with radiation, which can help make the radiation treatment more effective. The most common drugs used in this situation include:

  • Cisplatin

  • Cisplatin plus fluorouracil (5-FU)

  • Mitomycin-C with 5-FU

  • Paclitaxel (Taxol) 

Chemotherapy for bladder cancer usually uses more than one drug.

You may want to know what drugs you're taking if you're getting chemotherapy. You may want to know their common side effects. Your doctor and nurse will give you the details on your treatment. The specialist who treats you with chemotherapy is called a medical oncologist. To help deal with the medical information and remember all of your questions, it is helpful to bring a family member or close friend with you to your appointment with the medical oncologist. In addition, bringing a written list of concerns will make it easier for you to remember your questions about chemotherapy.

The different ways you can get chemotherapy for bladder cancer

The way you take chemotherapy drugs depends on your stage of cancer. There are two main ways of giving these drugs to treat bladder cancer. One way is intravesically, which is directly into the bladder. The other way is systemically.

If your cancer is in an early stage, you might get intravesical chemotherapy. This means that the drugs are put directly into your bladder through a tube inserted into your urethra. With this approach, the drugs mainly affect only cancer cells in the treated area. The drugs are less likely to harm other cells in your body than they would be if they were put into your bloodstream.

Another way to get chemotherapy is systemically. That means that the drugs travel through your whole body. You can get this type in any of these three ways:

  • Through injections (shots)

  • By intravenous drips (IVs)

  • By taking pills

Here's why systemic treatment is good. The drugs travel through most of the body, so they may be able to kill cancer cells that have spread. Surgery and radiation kill only the cells in the specific place that was treated. That means that they don't kill any cancer cells that may have escaped that area. Those escaped cells can grow in a different part of your body. Cancer that has spread is often harder to treat. If your cancer has spread, you will almost always have chemotherapy. That may be true even if you had surgery to remove the bladder cancer.

Chemotherapy is given in cycles. This reduces harm to healthy cells. Rest periods in between treatment give normal cells a chance to recover. Your doctor will decide if you need to get it daily, weekly, every few weeks, or monthly. Your treatment will usually last three to six months.

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

  • Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (called M-VAC)

  • Gemcitabine and cisplatin (called GemCIS)

  • Carboplatin and either paclitaxel/Taxol or docetaxel/Taxotere

There are other drugs that may be used in systemic chemotherapy of bladder cancer, such as bleomycin, cyclophosphamide (Cytoxan), ifosfamide (Ifex), methotrexate, and pemetrexed. 

Chemotherapy is usually given in an outpatient setting. That means you get it at a hospital, clinic, or doctor's office. You don't have to stay the night in the hospital. You will be watched for reactions during your treatments. Each of your treatments may last a while. So you may want to take along something that is comforting to you. Some people bring music to listen to. You may also want to bring something to keep you busy, such as a deck of cards or a book.


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