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
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 ok?
Before you have each treatment you’ll need to have a blood test to check your bloods are ok 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 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.
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.
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
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.