Chemotherapy for Bladder Cancer
Chemotherapy (chemo) is the use of drugs to treat cancer. Chemo for bladder cancer can be given in 2 different ways:
- Intravesical chemotherapy: For this treatment, the chemo drug is put directly into the bladder. This type of chemo is used only for very early-stage bladder cancers. It is described in Intravesical therapy for bladder cancer.
- Systemic chemotherapy: When chemo drugs are given in pill form or injected into a vein (IV) or muscle (IM), the drugs enter the bloodstream and travel throughout the body. This is called systemic chemotherapy. Systemic chemo can affect cancer cells far away from the main tumor.
When might chemotherapy be used?
Systemic chemo can be used :
- Before surgery to try to shrink a large tumor so that it can be removed more easily and to lower the chance the cancer will come back. Giving chemo before surgery is known as neoadjuvant therapy.
- After surgery (or sometimes after radiation therapy). This is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that remain after other treatments but are too small to be seen. This can lower the chance that the cancer will come back later.
- In people getting radiation therapy, to help the radiation work better.
- As the main treatment for advanced bladder cancers, such as those that have spread to distant parts of the body.
Which chemo drugs are used to treat bladder cancer?
Chemo drugs may be used alone or in combination, depending on what they’re being used for, a person’s overall health, and other factors.
When chemo is given with radiation, the most common drugs used include:
- Cisplatin plus fluorouracil (5-FU)
- Mitomycin with 5-FU
When chemo is used without radiation, the most common combinations include:
- Gemcitabine and cisplatin
- Methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (called MVAC)
- Cisplatin, methotrexate, and vinblastine (called CMV)
- Carboplatin and either paclitaxel or docetaxel (for patients with poor kidney function)
For some people, the side effects of getting more than one chemo drug might be too much to handle. For those people, treatment with a single drug, such as gemcitabine or cisplatin, may be a good option. Other drugs sometimes used alone for bladder cancer include carboplatin, docetaxel, paclitaxel, doxorubicin, 5-FU, methotrexate, vinblastine, ifosfamide, and pemetrexed.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each cycle typically lasts for a few weeks.
Most bladder cancers are transitional cell (urothelial) cancers, but there are other types as well, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Chemo for these rare types of bladder cancer may use drugs different from those listed above.
Side effects of chemotherapy
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and how long they are taken. When chemo and radiation are given at the same time, side effects tend to be worse. Common side effects of chemo include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Mouth sores
- Diarrhea or constipation
- Increased risk of infections (because of a shortage of white blood cells)
- Bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets)
- Fatigue (because of a shortage of red blood cells)
These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting. Ask your health care team about the side effects your chemo drugs may cause.
Some chemo drugs can cause other, less common side effects. For example, drugs such as cisplatin, carboplatin, docetaxel, and paclitaxel can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. This is called peripheral neuropathy. Some chemo drugs have been linked to an increased risk of leukemia later in life, but this is very rare.
Be sure to report any side effects to your medical team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to prevent the effects from getting worse.
To learn more about chemo, see the Chemotherapy section of our website.
Last Medical Review: January 26, 2016 Last Revised: May 23, 2016