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Chemotherapy into the bladder

Chemotherapy into the bladder is a treatment for early bladder cancer. You have it through a flexible tube called a catheter, which goes into your bladder.

Your doctor may call this treatment intravesical chemotherapy.

Having intravesical chemotherapy reduces the chance of the cancer coming back or spreading into the deeper layers of the bladder.

When you have it

You might have chemotherapy into your bladder as a one off (single dose) after a trans urethral resection of your bladder tumour (TURBT). For some people with early bladder cancer, this is all the treatment they need.

If you have a moderate risk of your cancer coming back, you have this treatment once a week for 6 weeks.

You may also have this treatment if your cancer comes back after the initial surgery and chemotherapy treatment.

Where you have chemotherapy

You usually have treatment at the cancer day clinic.

What happens

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Before each treatment you need to stop drinking fluids. This stops the urine from diluting the drug in your bladder and will help you hold the urine more easily. Your hospital will tell you when to stop drinking. 

How you have it

Single dose

The doctor or nurse puts a catheter through your urethra and into your bladder. The urethra is the tube that carries urine from the bladder to the outside of your body.

Your doctor or specialist nurse puts a liquid chemotherapy drug into the tube. The drug may be:

  • mitomycin C
  • epirubicin 
  • doxorubicin
Diagram showing how you have drug treatment into the bladder

Your doctor or nurse may then remove the catheter or clamp it.

You have to try not to pass any urine for the next 1 to 2 hours. This gives the chemotherapy drugs time to be in contact with the lining of the bladder. Some hospitals may ask you to change position every now and again to make sure the drug reaches all parts of your bladder lining.

You then pass urine naturally to get rid of the chemotherapy drug. Or your nurse may drain it out through a catheter.

A course of chemotherapy into your bladder

Every session the nurse or doctor puts a catheter through your urethra and into your bladder (if you haven't got one in already). Your doctor or specialist nurse puts a liquid chemotherapy drug into the catheter.

You usually keep the drug in the bladder for 1 or 2 hours. Some hospitals may ask you to change position every now and again to make sure the drug reaches all parts of your bladder.

After the time is up your nurse will drain the liquid out through the catheter. If you have had the catheter removed after the medicine was put in you will need to use the toilet.  

Some hospitals allow you to go home with the medicine in your bladder if you live close by and are okay with the treatment. Your team will let you know if you can do this. 

When you go home

Having bladder cancer and its treatment can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

You’ll be told you need to drink lots of fluid (2-3 litres) after this treatment. It helps clear your system of chemotherapy.

You have to be careful when you pass urine so that you don't get it on your skin. Men should sit down to pass urine, to reduce the chance of splashing. The urine contains some chemicals from the chemotherapy which could irritate your skin. 

If you use the toilet then you must wash your genitals and hands immediately with warm soapy water to prevent the chemotherapy from irritating your skin.

Side effects

You get fewer side effects having chemotherapy into your bladder than you would having chemotherapy into a vein. This is because the drug tends to stay in your bladder. So very little of it gets into your bloodstream.

Some of the side effects might include:

Irritation of the bladder 

Chemotherapy can irritate your bladder. You may feel as if you have a bad urine infection (cystitis). This can make you :

  • pass urine very often
  • pass urine with urgency 
  • feel uncomfortable
  • feel some pain

Blood in your urine

You may have a small amount of bleeding. Contact the hospital immediately if:

  • the bleeding is getting worse
  • there are blood clots in your urine
  • you have severe pain when passing urine
  • you can't pass urine and have severe pain

Skin rash and itching

You may get a rash on your hands or feet for a short time after having this treatment. Some skin rashes may get red, sore and swollen. Some people get severe itching. Contact your doctor if you get any of these symptoms.

Infection

Some chemotherapies can increase your risk of getting an infection. You're also at increased risk of infection from having a catheter put in. If you generally feel unwell, severe pain, bad smelling urine or discharge or have a temperature contact your doctor.   

Allergic reaction

There is a risk of having an allergic reaction to the chemotherapy. But this is rare. If it does happen the nurse gives you medicines to control the reaction. Tell the doctor or nurse if you feel unwell at any time.

Last reviewed: 
22 Jul 2019
  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence, 2015

  • Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1 and CIS)
    M Babjuk and others
    European Association of Urology, 2017

  • Intravesical instillation with mitomycin C or bacillus Calmette – Guerin in non-muscle invasive bladder cancer
    S Vahr and others
    European Association of Urology Nurses, 2015

  • Bladder cancer: overview and disease management. Part 1: non-muscle-invasive bladder cancer.
    B Anderson
    British Journal of Nursing, 2018. Volume 29, Number 9, Pages 27-37

  • Bladder cancer
    A M Kamat and others
    The Lancet, 2016. Volume 388, Pages 2796 - 2810

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

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