Chemotherapy for bladder cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.

For muscle invasive bladder cancer you have the drugs into a vein (intravenously). As the drugs circulate in your blood, they travel throughout your body. They work by disrupting the growth of cancer cells.

This is different to having chemotherapy into the bladder for non muscle invasive bladder cancer.

When do you have it?

You might have chemotherapy:

  • before surgery or radiotherapy 
  • alongside radiotherapy, to make the radiotherapy work better (chemoradiotherapy)
  • after surgery - if you didn’t have it before
  • as your main treatment, if your cancer has spread (metastatic cancer)

Chemotherapy before surgery or radiotherapy can shrink the tumour. It aims to make the treatment work better. Doctors call this neoadjuvant chemotherapy. It can lower the risk of bladder cancer coming back in the future.

Chemotherapy after surgery may help to stop the cancer coming back. This is called adjuvant chemotherapy. You might have it if you didn't have chemotherapy before your surgery.

This page is about neoadjuvant and adjuvant chemotherapy. We have a separate page about chemoradiotherapy.

We also have a separate page about chemotherapy for bladder cancer that has spread (metastatic bladder cancer).

Types of chemotherapy

You usually have neoadjuvant chemotherapy before surgery or radiotherapy. You have several drugs together. The most common combinations include:

  • gemcitabine and cisplatin (GC)
  • methotrexate, vinblastine, doxobrubicin and cisplatin (MVAC)

You might have chemotherapy alongside radiotherapy. This is called chemoradiotherapy. You might have:

  • a combination of 2 chemotherapy drugs - mitomycin C and fluorouracil (5FU)
  • cisplatin

How you have it

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 you have chemotherapy

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.

Before you start chemotherapy

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

Side effects

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
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

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.

Most side effects only last for a few days or so. Your treatment team can help to manage 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.

When you go home

Chemotherapy 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.

After your chemotherapy

When you have chemotherapy before surgery or radiotherapy, your doctor needs to know how well it is working. You might have a cystoscopy or CT scan during or after your course of chemotherapy. This can show your doctor whether the cancer has shrunk.

When you have chemotherapy after surgery, you have the normal follow up appointments.

  • Bladder cancer: diagnosis and management
    National Institute for Health and Care Excellence (NICE), February 2015

  • Managing locally advanced or metastatic bladder cancer
    National Institute for Health and Care Excellence, 2018

  • EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer
    J A Witjes and others
    European Association of Urology, 2022

  • Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up.
    T Powles and others
    Annals of oncology, 2022 Volume 33, Issue 3, Page 244 - 258

  • BMJ Best Practice. Bladder Cancer
    D Lamm and others
    BMJ Publishing Group Ltd, 2018

  • 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 with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
02 Dec 2022
Next review due: 
02 Dec 2025

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