Bladder cancer chemotherapy is given in two ways- directly into the bladder with the help of a catheter and intravenously. It is a single drug therapy or sometimes a combination of drugs. In case of bladder cancer, neoadjuvant therapy is used i.e. chemotherapy is given before the surgery to shrink the tumor.

Adjuvant therapy i.e. chemotherapy given after surgery is used for early bladder cancers which are not widely spread. This kills the remaining cancer cells in the body after surgery or a TUR i.e. transurethral resection.

Intravesical chemotherapy is given locally. In this, a tube or catheter with liquid drugs is inserted through the urethra into the bladder. The drugs are kept in the bladder for several hours to affect the cancerous cells. This treatment is done once a week for several weeks.

If the bladder cancer is spread to lymph nodes or other organs, chemotherapy is given intravenously. This is called intravenous bladder cancer chemotherapy. The drugs in this type are generally given in cycles so that the patient gets a recovery period after every treatment. Depending on the drugs administered and the patient’s overall health, a short stay in the hospital would be required for this treatment.

Drugs for Intravenous Chemotherapy

• M-VAC stands for a combination of methotrexate, vinblastine, doxorubicin, and cisplatin. Methotrexate is frequently used in combination chemotherapy as it slows the tumor growth. Cisplatin is a heavy metal that kills the cancer cells as it interferes with the multiplication of cancer cells.
• Gemcitabine is an anti tumor medication that intervenes with cell division. It is combined with cisplatin.
• Doxorubicin is an anthracycline antibiotic. Other anthracycline antibiotics like epirubicin and valrubicin are also used in bladder cancer chemotherapy.
• Paclitaxel or carboplatin are anti tumor medicines that slow down the tumor growth.

Drugs for Intravesical Chemotherapy

• Bacillus Calmette-Guerin (BCG) is a drug used as a part of immunotherapy. This stimulates an immune response or inflammation in the bladder wall to destroy the cancer cells in the bladder.
• Mitomycin is an anti tumor antibiotic drug that stops the multiplication of cancer cells. It prevents recurrence of bladder cancer if administered directly into the bladder.

Side Effects of Bladder Cancer Chemotherapy

In case of Intravesical chemotherapy, the side effects are irritation, discomfort or bleeding and rash if the drugs react with the genitals or the skin. These side effects are temporary.

In case of systemic bladder cancer chemotherapy or intravenous therapy, the side effects are low blood cell counts, hair loss, loss of appetite and nausea. These side effects are also temporary.

Blood cells: The drugs target the blood cells and depending on the type of blood cell targeted, the patient would experience weakness, loss of immunity or bruising.

Cells in hair roots are targeted by some drugs that leads to hair loss. However, the hair grows back mostly with a different color and texture.

Cells that line the digestive tract are also targeted by some drugs, which cases loss of appetite, nausea and vomiting, diarrhea or mouth sores.

Bladder cancer chemotherapy can be effective if the cancer is detected early. However, some drugs used in this also damage the kidneys. Hence, it is essential that the patient has a lot of fluid intake including plenty of water during and after this treatment. Some fluids are also administered intravenously by the doctor. There would be certain side effects like tingling in the fingers, ringing in the ears, etc which would subside after the treatment.