Intravesical chemotherapy

Intravesical Chemotherapy is a treatment given into the bladder. It contains a drug that destroys abnormal and possible cancerous cells. It is described as a cytotoxic drug and its name is Mitomycin-C.

The treatment is a form of chemotherapy, but because it is given into the bladder and not the blood stream you should experience very few side effects as the drug stays inside your bladder and does not affect other parts of your body.

The treatment may cause some side effects; these are described later in more detail. The treatment can be given after specific operations e.g. Cystoscopy or Trans Urethral Resection of Bladder Tumour (TURBT). Alternatively you may need to have a course of treatment, usually once a week for six weeks. This will be as an outpatient. The treatment involves a small amount of fluid, containing the drug; being passed through a catheter, which is a fine hollow tube placed into your bladder and held there for one hour, this is to make sure that the fluid comes into contact with the whole of your bladder lining.

This will depend on how aggressive (grade) and how deep (stage) the bladder cancer is.

Approximately seven out of ten people with a superficial bladder cancer and / or carcinoma in situ will respond to treatment. These are cancers that affect the inner linings of the bladder wall.

Sometimes, even for those people who have had successful chemotherapy treatment, the bladder cancer may return and need to be removed again.

The treatment can be given immediately after your operation or as an outpatient. The treatment is given as an outpatient at the Princess Royal Hospital by a nurse trained in the procedure.

• Before we give you the first treatment we will ask you about any previous illnesses, operations you have had and about any medication you may be taking.
• We will then ask you for your consent to give you the treatment.
• After making yourself comfortable on an examination couch or bed, the genital area will be cleaned with some normal saline solution and a fine catheter is inserted into the bladder, via the urethra, the tube through which your urine drains from. This may be already there if you have just had an operation.
• The mitomycin treatment is then passed through the catheter into the bladder and the catheter is then removed or clamped.
• We will ask you not to pass urine for the next hour.
• Once we have removed the catheter, you may go home. Please make sure you know when your next treatment or appointment will be.

• Please reduce your fluid intake before treatment; this will reduce the amount of urine you make so you can be comfortable and retain the treatment for the hour.
• If you take diuretic medicines (‘water tablets’), you should take them after treatment or at least six hours before the appointment.
• You will be asked to provide a urine sample on arrival, alternatively you can bring a sample with you. We will test it to make sure there is no infection in your bladder. If there were then we would have to postpone the treatment and prescribe you antibiotics, because infection makes complications after the treatment more likely.
• If you feel unwell, or are unable to make the appointment, please let us know as soon as possible.

• You should sit down when passing urine for the 4 hours after treatment. This reduces the risk of spillage onto skin or outside the toilet. Also, washing around the genital area (with soap and water after each time you go to the toilet) is recommended during this period.
• After you pass urine for the first time following the instillation, before flushing, add two cups of undiluted household bleach into the toilet, leave for 15 minutes and then flush.
• Ensure no one else uses the toilet before flushing.
• Make sure you wash your hands thoroughly each time.
• Drink plenty of fluids (2-3 litres) for the first 24 hours following treatment. Try to avoid caffeine drinks e.g. coffee, coke and tea as they can irritate the lining of the bladder. Alcohol should also be avoided. Use decaffeinated drinks, cranberry juice and barley waters.
• Men should use a condom during sex for the first 48 hours after chemotherapy. If you are a woman having the treatment your partner should use a condom. Using a condom will protect your partner from any of the drug that may still be present in semen or vaginal fluid.

Most commonly, these include:

• Pain when passing urine and passing urine more frequently; this may feel like cystitis. Drinking plenty of fluids will help reduce these symptoms.
• Flu-like symptoms for 2-3 days.
• Blood in your urine.
• Debris in your urine.

However, if they continue to last more than 3 days, then contact your G.P.

Less commonly:

• Skin rash – an antihistamine, such as Piriton, may be prescribed if your rash is particularly itchy.
• Failure to complete the course due to discomfort.
• Infection.
• Stricture of the Urethra.

Very uncommon

It is important that you see a doctor or go to the Accident & Emergency department if you develop any of these symptoms:

• High temperature (above 39ºC).
• Allergic reaction.
• Sweating.
• Shivering.
• Unable to pass urine.

If you do see a Doctor, please let them know that you are receiving mitomycin treatment for bladder cancer.

Initial Mitomycin given post-operatively:

1st Mitomycin course

Next follow up:   ________________________________________________________________

The Urology Nursing Team: 01444 441881 Extension 65457.

Email: uhsussex.urologyclinicalnursingteam@nhs.net

Urology Consultants:

Mr Coker’s secretary 01444 441881 Ext. 68043
Mr Crawford’s secretary 01444 441881 Ext. 65962
Mr Symes’ secretary 01273 696955 Ext. 67809
Mr Larner’s secretary 01273 696955 Ext. 67808
Mr Alanbuki’s secretary 01273 696955 Ext. 67810
Mr Zakikhani’s secretary 01273 696955 Ext. 67809