Having chemotherapy for bladder cancer

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

For 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.

When do you have it?

You might have chemotherapy:

  • during radiotherapy treatment (chemoradiotherapy)
  • before radiotherapy
  • before or after surgery
  • as a main treatment, if your cancer has spread (advanced bladder cancer)

Chemotherapy before surgery or radiotherapy can shrink the tumour. It aims to make the treatment work better. This is called 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. You usually have a combination of drugs. The most common combinations include:

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

How you have it

Chemotherapy for invasive bladder cancer is nearly always a course of treatment, taking several months in total. You have chemotherapy treatment into a vein and then have a break of a week or two. This makes up one cycle of chemotherapy treatment. Then you have the same treatment again.

Each cycle of treatment varies in time depending on the chemotherapy you are being given.

Chemotherapy before surgery or radiotherapy usually 3 cycles. Chemotherapy after surgery or radiotherapy, or alongside radiotherapy, can be 6 or more cycles.

Your specialist will explain the length of time they expect your course of chemotherapy to be.

Where you have it

Usually you have the treatment in the outpatient department of a hospital.

Specialist chemotherapy nurses inject your chemotherapy drugs or you may have the drugs through a drip over a longer time. This depends on the type of chemotherapy you have. You usually you can go home after your treatment.

You usually have chemotherapy through a small tube called a cannula. Or you may have it through a central line, the most common type being a PICC (peripherally inserted central catheter) line.

Watch this short 3 minute video on what it's like to have chemotherapy

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.

The blood tests check how well your kidneys are working, and also check your blood cell levels. If your blood cell count is low, you are at risk of getting a serious infection, bruising and bleeding if you have more treatment. Your specialist may delay your next treatment for a week or so. In some cases your specialist may have to lower your chemotherapy dose.

Nutritional supplements and other remedies or medicines

We don't yet know much about how some nutritional or herbal supplements may interact with chemotherapy. But some could be harmful.

It is very important to let your doctors know if you take any supplements. And tell them if you are prescribed any remedies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having treatment.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking, or thinking of taking, these supplements talk to your doctor to find out whether they could affect your treatment.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • 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.

When you go home

Chemotherapy for invasive bladder cancer 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

After you have chemotherapy before surgery or radiotherapy, your doctor needs to know how well the chemotherapy has worked. You may be asked to have a cystoscopy or CT scan after your course of chemotherapy (or sometimes halfway through). This can show your doctor whether the cancer has shrunk.

When you have had chemotherapy after surgery, you then have the normal follow up appointments to help stop the cancer coming back.

Last reviewed: 
19 Jun 2019
  • 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, 2017

  • Bladder cancer: ESMO Practice Guidelines for diagnosis, treatment and follow-up
    J Bellmunt and others
    Annals of Oncology, 2014. Volume 25, Issue 3, Pages 40-48

  • 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 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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