Treatment into the bladder
This page tells you about treatment into the bladder for early stage bladder cancer. Doctors call this intravesical therapy and there is information about
Treatment into the bladder
Treatment into the bladder is called intravesical treatment. The aim is to treat the cancer and stop it coming back. You can have intravesical treatment with chemotherapy drugs or with BCG vaccine.
After surgery to remove bladder cancer, you have a tube (catheter) put into your bladder. The BCG or chemotherapy drug goes into your bladder through the catheter. You have to try not to pass urine for the next 2 hours.
Chemotherapy into the bladder
Chemotherapy into the bladder is called intravesical chemotherapy. This helps to stop the bladder cancer growing back. You may have it just once, or have weekly treatment for 6 weeks. Bladder irritation is usually the only side effect. Some people get a rash on their hands or feet for a short time after treatment.
BCG into the bladder
BCG given into the bladder is called intravesical BCG. BCG is a vaccine for tuberculosis (TB). Doctors are not quite sure how it works for bladder cancer, but they know from research that it helps to stop or delay bladder cancers growing back. You usually have this treatment weekly for 6 weeks. You may then have it every few weeks or months for the next 3 years. You may get an irritated bladder or want to pass urine more often. Some people have flu like symptoms after treatment. There is a very small chance that some of the TB could get into your system and give you TB symptoms. If you are worried, tell your doctor or nurse straight away.
Newer ways of giving chemotherapy into the bladder
Doctors are testing some new ways of giving chemotherapy into the bladder. They want to know if these make the treatment work better. They sometimes call this device assisted chemotherapy, or device assisted intravesical therapies. There are different methods. These include using an electric current (called electrically stimulated chemotherapy or electromotive drug administration (EMDA)). And using heated agents (called hyperthermic mitomycin, intravesical microwave hyperthermia with chemotherapy, or the Synergo technique, or hyperthermic intravesical chemotherapy (HIVEC)). These treatments are specialised and may only be available in hospitals with a special interest in treating bladder cancer.
You can view and print the quick guides for all the pages in the Treating bladder cancer section.
Intravesical therapy for bladder cancer means putting liquid drugs directly into the bladder through a tube called a catheter. The aim of this treatment is to treat the cancer and stop it from coming back or spreading into the deeper layers of the bladder.
After surgery to remove early bladder cancer you have a catheter (tube) put into your bladder through the urethra. Your doctor or specialist nurse puts a chemotherapy drug into the tube. The chemotherapy drug may be mitomycin C, epirubicin or doxorubicin. The doctor or nurse may then remove the catheter. You have to try not to pass any urine for the next 2 hours. This gives the treatment time to be in contact with the lining of the bladder. You then pass urine naturally to get rid of the chemotherapy drug. Or your nurse drains the chemotherapy out through a catheter. For some people with early bladder cancer, this is all the treatment they need.
If you have a moderate or high risk of the cancer coming back you need to have further treatment into the bladder with
People who have a moderate risk of the cancer coming back usually have further treatment with chemotherapy into the bladder (intravesical chemotherapy). This is to reduce the chance of the cancer coming back or spreading. You have a solution of a chemotherapy drug (mitomycin, epirubicin or doxorubicin) put into your bladder weekly for 6 weeks. You may also have this treatment if your cancer comes back after the initial surgery and chemotherapy treatment.
The chemotherapy is a liquid given into the bladder through a flexible tube (catheter) put into the urethra. You may need to stop drinking fluids for up to 12 hours before the treatment. This stops the urine from diluting the drug. You usually keep the drug in the bladder for an hour. During this time you will need to change position every now and again to make sure the drug reaches all parts of your bladder. Then your nurse will drain the liquid out through the catheter.
For 6 hours after the treatment, you have to be careful when you pass urine so that you don't get the urine on your skin. The urine contains some chemicals from the chemotherapy. If the urine does get on to your skin you need to thoroughly wash the area with soap and water but don't scrub it.
Men should sit down to pass urine, to reduce the chance of splashing. You should try not to get any urine on your hands because the chemotherapy may irritate your hands.
Giving chemotherapy into the bladder does not have as many side effects as having chemotherapy tablets or injections. The drug tends to stay in your bladder and very little of it gets into the bloodstream.
The main side effect is irritation of the bladder. You may feel as if you have a bad urine infection (cystitis). If you have this side effect you will feel that you want to pass urine very often and it may be uncomfortable when you do pass urine. About 1 out of 10 people (10%) develop a rash on their hands or feet for a short time after having the treatment.
People who have a high risk of the cancer coming back or spreading into the deeper layers of the bladder usually have treatment with BCG into the bladder (intravesical BCG).
BCG is a vaccine for tuberculosis (TB). It is also very good at helping to stop or delay bladder cancers growing back or spreading into the deeper layers of the bladder. You usually have BCG treatment weekly for 6 weeks. You may also have another BCG intravesical therapy 6 weeks after your last weekly treatment, and then every few weeks or months for the next 3 years. This is called maintenance BCG therapy.
The BCG is a liquid. Your doctor or nurse put the liquid into your bladder through a tube (catheter) in the urethra. They usually then remove the catheter. You should not pass urine for 2 hours. When you do pass urine, you need to be careful for 6 hours after the treatment because the vaccine contains live TB. Men should sit down to pass urine, to reduce the chance of splashing. You should try not to get any urine on your hands. After you've been to the loo, pour about half a pint of neat bleach into the toilet bowl and leave it for 15 minutes before flushing. This makes sure you are not flushing live TB into the sewer system. Then wash your hands because the treatment may irritate your skin.
Doctors are not quite sure how BCG works for bladder cancer. It seems to encourage cells of the immune system to grow and become very active in the lining of the bladder. BCG seems to work as a type of immunotherapy. These cells of the immune system probably kill off any cancer cells that might grow back or have been left behind in the bladder lining.
A review of medical studies in this area has found that this treatment does help to stop bladder cancers coming back in many people.
You probably won't have too many side effects from this treatment, although it can cause more side effects than chemotherapy into the bladder.
- About 2 out of 3 people have an irritated bladder which feels a bit like having a urine infection
- About 7 out of 10 people want to pass urine more often than usual
- About 1 in 4 people have blood in their urine
- About 1 in 2 people have flu like symptoms for 24 to 48 hours after each treatment
- About 1 or 2 out of 100 people have painful joints
If you have any of these symptoms, tell your doctor at your next appointment.
There is also a very small chance that some of the TB could get into your system and give you TB symptoms such as
- Fever and chills
- Joint pain
- Feeling sick or vomiting
- Skin rash
- Feeling extremely tired
These effects only happens to fewer than 1 person in every 100 who has this treatment. It is important that you tell your doctor straight away if you have any of these symptoms or have a high temperature for more than 48 hours. You may need treatment with anti TB drugs and should not wait until your next appointment to let your doctor know.
Doctors are testing some new ways of giving chemotherapy into the bladder. They want to know if these make the treatment work better. They sometimes call this device assisted chemotherapy, or device assisted intravesical therapies. Researchers are looking at methods which include
- using an electric current (called electrically stimulated chemotherapy or electromotive drug administration (EMDA))
- using heated agents (called hyperthermic mitomycin, intravesical microwave hyperthermia with chemotherapy, the Synergo technique or hyperthermic intravesical chemotherapy (HIVEC))
These treatments are specialised and may only be available in hospitals with a special interest in treating bladder cancer.
Electrically stimulated chemotherapy
Your doctor may suggest electrically stimulated chemotherapy if you have a high grade cancer that remains or comes back after chemotherapy or BCG into the bladder. This treatment aims to make the chemotherapy work better by using an electrical current. The current makes it easier for the bladder lining to absorb the chemotherapy. It is called electrically stimulated intravesical chemotherapy, or electromotive drug administration (EDMA). It is also known as iontophoresis (pronounced i-on-toe-for-ee-sis).
To have EMDA treatment you have a tube (catheter) with a small electrode put into your bladder. Your bladder must be empty and so you have an ultrasound scan to check. The doctor then washes out your bladder with sterile water and sticks two patches on to your skin, on the lower part of your tummy (abdomen). The patches also contain electrodes.
Your doctor attaches the wires from the electrodes to a small generator. They put the chemotherapy drug into your bladder through the catheter and switch the generator on. A small electrical current passes through the patches. The electrical current draws the drug into the cells of the bladder lining. You may have a small tingling feeling but it isn’t painful. You have the treatment once a week for 6 weeks. Each treatment lasts for about 30 minutes. After the procedure the doctor or nurse drains the chemotherapy out of the bladder and takes out the catheter.
The side effects you may have are
- Pain passing urine
- Passing urine more often
- Blood in your urine
- Flu like symptoms including fever
- Urine infection
- Irritation and redness from the patches on your abdomen
The National Institute for Health and Care Excellence (NICE) has announced that this procedure can be used, either before or after surgery, for early (superficial) bladder cancer. But it can only be used as part of clinical trials, because we don't yet have enough evidence to really know how well it works.
Hyperthermia mitomycin C
Your doctor may suggest this treatment either before or after surgery to remove early bladder cancer. The treatment uses a microwave probe to heat the wall of the bladder, at the same time as putting in the chemotherapy drug mitomycin C. It is called hyperthermic mitomycin, intravesical microwave hyperthermia with chemotherapy, or the Synergo technique. You have it as an outpatient.
You have a local anaesthetic into the bladder. Then you have a tube (catheter) into your bladder through the urethra. The doctor passes chemotherapy and a probe into the bladder through the catheter. The probe uses microwaves to heat up the bladder lining. This heat treatment appears to make the cancer cells more sensitive to the chemotherapy and doctors hope this will make the chemotherapy work better and improve results.
The National Institute for Health and Care Excellence (NICE) has announced that this procedure could be used, either before or after surgery, for bladder cancer that has not grown further than the bladder lining. But it can only be done as a part of clinical research. NICE says there is not enough evidence for how well this procedure works to make it more widely available. This treatment has sometimes worked well for people with high grade, early bladder cancer after BCG treatment into the bladder has not worked. It may help people in this situation to avoid having their bladder removed.
The main side effect is irritation of the bladder, and you may feel as if you have a bad urine infection (cystitis). But most people recover quickly.
Doctors are looking at another way of giving hyperthermic mitomycin C. This is called HIVEC (Hyperthermic Intra-VEsical Chemotherapy. For HIVEC you have a catheter (tube) put into your bladder through your urethra. A device heats the mitomycin C and your doctor puts the heated chemotherapy drug into the catheter. This treatment is being looked at in the HIVEC II trial.
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