Chemotherapy for metastatic bladder cancer
Chemotherapy is a common treatment for metastatic bladder cancer. Chemotherapy uses anti cancer drugs to destroy cancer. The drugs circulate throughout the body in the bloodstream.
Metastatic bladder cancer means the cancer has spread to another part of your body. It is also called advanced cancer. Chemotherapy for metastatic bladder cancer can often shrink the cancer or keep it under control for some time.
There are different types of chemotherapy drugs. You usually have a combination of drugs together.
When do you have it?
Some chemotherapy treatments for advanced bladder cancer can be quite intensive and have a lot of side effects. So when they make treatment decisions, your doctor will think about:
- how unwell you are because of your cancer
- what other medical problems you have (such heart, lung or liver problems)
- what cancer treatment you have had before
- how well your kidneys are working
- the side effects of the chemotherapy
- what other treatment options there are
You can have less intensive types of chemotherapy if the doctor doesn’t think you are well enough to manage the side effects of the more intensive treatments. They can still work very well at shrinking the cancer and slowing its growth.
What chemotherapy will I have?
Some of the common chemotherapy combinations for metastatic bladder cancer include:
- accelerated MVAC (methotrexate, vinblastine, doxorubicin and cisplatin)
- Gemcitabine and Cisplatin
- Gemcitabine and Carboplatin
It’s best to talk to your doctor about what type of chemotherapy treatment they think is most suitable for you and why.
If you had chemotherapy when you were first treated, your doctor will assess how well the chemotherapy worked for you then. Then they can decide whether it is likely to work well now, or whether other chemotherapy drugs might work better for you.
How you have chemotherapy
Before you start
You need to have blood tests to make sure it’s safe to start treatment. You usually have these the day before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
You have chemotherapy into a vein (intravenously). This means you have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
You usually have chemotherapy as cycles of treatment. Each cycle is either a 2, 3 or 4 week period. The cycle length varies in time depending on the chemotherapy you are having.
You usually have 3 cycles of chemotherapy before surgery or radiotherapy. After surgery or radiotherapy, you might have 6 or more cycles.
Your specialist will explain how you have treatment, and how long they expect your treatment course to be.
Where do you have it?
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.