What is chemotherapy?
Chemotherapy is drug treatment given to treat cancers. It may be given in addition to other treatments such as radiotherapy, after an operation or on its own.
There are two types of chemotherapy in bladder cancer
- Intravesical chemotherapy
- Systemic chemotherapy
Intravesical chemotherapy is drug-treatment given directly into the bladder usually via a catheter put into the bladder via the urethra. This treatment is usually given for patients who have certain types of superficial bladder cancer where there has been no spread into the muscle of the bladder wall. (see section on intravesical treatment). This treatment is usually arranged by the urology team.
Systemic chemotherapy is drug treatment given via a drip into the veins. An oncologist will always be the doctor involved in deciding whether chemotherapy is needed and which chemotherapy will be the best for you.
Systemic chemotherapy can be given in a number of different situations in bladder cancer:
- Neo-adjuvant chemotherapy
Neo-adjuvant chemotherapy is given before a cystectomy (operation to remove the bladder) or before a radical (potentially curative) course of radiotherapy to improve the results of the radiotherapy or surgery.
Usually three cycles of chemotherapy are given (see below) and then you may have another telescope test (rigid cystoscopy) and CT /MRI scan to assess the response in the bladder to chemotherapy. Not all patients who are due to have either radical cystectomy or radical radiotherapy will be suitable for neoadjuvant chemotherapy. It depends on a number of factors such as how well your kidneys work, any other medical problems and the type of the bladder cancer
- Down-staging chemotherapy
If the bladder cancer has spread beyond the bladder into the surrounding tissues or to the lymph glands near to the bladder on the CT/MRI scans, but there is no spread elsewhere in the body you may be offered chemotherapy to downstage the cancer and see if either surgery or radiotherapy may then be possible. Three to six cycles of chemotherapy are usually given, with a CT/MRI scan done after three cycles to assess response to the chemotherapy.
- Palliative chemotherapy
Palliative chemotherapy is given when there is evidence on CT/MRI of spread of the cancer beyond the bladder itself outside of the pelvis into other organs such as the lymph glands in the chest or abdomen, or into the lungs, or liver. Chemotherapy is usually given to improve quality of life and to help with any symptoms from the bladder cancer, and also to improve prognosis. Bladder cancer tends to be very sensitive to chemotherapy with a response rate of 60% . This means that 6 in 10 patients will feel better, or their scans will improve with chemotherapy but the chemotherapy is very unlikely to be a cure. The majority of patients will relapse at some point in the future and the point at which this may happen is different for each patient. Your oncologist will discuss this with you and will discuss what the aims of treatment are.
Sometimes the same type of chemotherapy can be used again if the cancer comes back, or a different type of chemotherapy may be suggested.
How is chemotherapy given?
Most chemotherapy is given as an out-patient in an oncology unit. The nurses are specially trained in talking to you about chemotherapy and giving the treatment.
Before you start your treatment you will need to have a blood test, either on the same day or beforehand. You will also be seen by a doctor or nurse and if the results of your blood tests are normal, the pharmacy will make up the chemotherapy drugs which can take several hours.
The nurse will then insert a fine plastic tube (cannula) into a vein in your arm. It may feel a little uncomfortable whilst it is being inserted. Sometimes, chemotherapy is given through a vein in the crook of the arm (PICC line) or through a fine plastic tube inserted under the skin into a long vein near the collar bone. This is called a central line.
Before the chemotherapy is given, you will be given an anti-sickness drug which may be given though the cannula or as a tablet. If you are having outpatient treatment, you can go home after the chemotherapy. The cannula is removed before you go home, unless you have a PICC or central line. If you have either a PICC or central line, you will be taught how to look after it whilst at home and how to shower etc with it in place.
You will also be given a supply of anti-sickness medication to take home with you. It is important to take these regularly to avoid the risk of being sick. If you find that you are feeling sick, have a temperature, sore throat, diarrhoea or any other side effects from the treatment, it is important that you seek medical advice. You will be given the contact telephone numbers of members of the chemotherapy team to contact, and it is important that you seek advice even if it is in the middle of the night if you feel unwell.