Intravesical Chemotherapy

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What is Intravesical Chemotherapy?

Intravesical Chemotherapy is a treatment given into the bladder. It contains a drug that destroys abnormal and possible cancerous cells. It is described as a cytotoxic drug and its name is Mitomycin-C.

The treatment is a form of chemotherapy, but because it is given into the bladder and not the blood stream you should experience very few side effects as the drug stays inside your bladder and does not affect other parts of your body.

The treatment may cause some side effects; these are described later in more detail. The treatment can be given after specific operations e.g. Cystoscopy or Trans Urethral Resection of Bladder Tumour (TURBT). Alternatively you may need to have a course of treatment, usually once a week for six weeks. This will be as an outpatient. The treatment involves a small amount of fluid, containing the drug; being passed through a catheter, which is a fine hollow tube placed into your bladder and held there for one hour, this is to make sure that the fluid comes into contact with the whole of your bladder lining.

How effective is treatment?

This will depend on how aggressive (grade) and how deep (stage) the bladder cancer is.

Approximately seven out of ten people with a superficial bladder cancer and / or carcinoma in situ will respond to treatment. These are cancers that affect the inner linings of the bladder wall.

Sometimes, even for those people who have had successful chemotherapy treatment, the bladder cancer may return and need to be removed again.

How is the treatment given?

The treatment can be given immediately after your operation or as an outpatient. The treatment is given as an outpatient at the Princess Royal Hospital by a nurse trained in the procedure

• Before we give you the first treatment we will ask you about any previous illnesses, operations you have had and about any medication you may be taking
• We will then ask you for your consent to give you the treatment
• After making yourself comfortable on an examination couch or bed, the genital area will be cleaned with some normal saline solution and a fine catheter is inserted into the bladder, via the urethra, the tube through which your urine drains from. This may be already there if you have just had an operation
• The mitomycin treatment is then passed through the catheter into the bladder and the catheter is then removed or clamped
• We will ask you not to pass urine for the next hour
• Once we have removed the catheter, you may go home. Please make sure you know when your next treatment or appointment will be

Do I need to do anything before treatment?

• Please reduce your fluid intake before treatment; this will reduce the amount of urine you make so you can be comfortable and retain the treatment for the hour
• If you take diuretic medicines (‘water tablets’), you should take them after treatment or at least six hours before the appointment
• You will be asked to provide a urine sample on arrival, alternatively you can bring a sample with you. We will test it to make sure there is no infection in your bladder. If there were then we would have to postpone the treatment and prescribe you antibiotics, because infection makes complications after the treatment more likely
• If you feel unwell, or are unable to make the appointment, please let us know as soon as possible

Are there any special precautions after treatment

• You should sit down when passing urine for the 4 hours after treatment. This reduces the risk of spillage onto skin or outside the toilet. Also, washing around the genital area (with soap and water after each time you go to the toilet) is recommended during this period
• After you pass urine for the first time following the instillation, before flushing, add two cups of undiluted household bleach into the toilet, leave for 15 minutes and then flush
• Ensure no one else uses the toilet before flushing
• Make sure you wash your hands thoroughly each time
• Drink plenty of fluids (2-3 litres) for the first 24 hours following treatment. Try to avoid caffeine drinks e.g. coffee, coke and tea as they can irritate the lining of the bladder. Alcohol should also be avoided. Use decaffeinated drinks, cranberry juice and barley waters
• Men should use a condom during sex for the first 48 hours after chemotherapy. If you are a woman having the treatment your partner should use a condom. Using a condom will protect your partner from any of the drug that may still be present in semen or vaginal fluid

Are there any side effects?

Most commonly, these include:

• Pain when passing urine and passing urine more frequently; this may feel like cystitis. Drinking plenty of fluids will help reduce these symptoms
• Flu-like symptoms for 2 to 3 days
• Blood in your urine
• Debris in your urine

However, if they continue to last more than 3 days, then contact your GP.

Less commonly:

• Skin rash – an antihistamine, such as Piriton, may be prescribed if your rash is particularly itchy
• Failure to complete the course due to discomfort
• Infection
• Stricture of the urethra

Very uncommon

It is important that you see a doctor or go to the Accident & Emergency department if you develop any of these symptoms:

• High temperature (above 39ºC)
• Allergic reaction
• Sweating
• Shivering
• Unable to pass urine

If you do see a Doctor, please let them know that you are receiving mitomycin treatment for bladder cancer.

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