Intravesical chemotherapy is a localized treatment that delivers cancer-fighting medication directly into the bladder using a thin, flexible tube called a catheter. The medicine primarily affects the cells that form the inner lining of the bladder wall. Because the drug is concentrated inside the bladder, its effects on other parts of the body are minimal compared to systemic chemotherapy, where drugs circulate throughout the body.
Conditions Treated by Intravesical Chemotherapy
This form of treatment is used for non-muscle invasive bladder cancer (NMIBC), a cancer confined to the bladder’s superficial lining that has not penetrated the deeper muscle layer. The specific stages of NMIBC often treated include Ta, T1, and Carcinoma in Situ (CIS). The goal is to eliminate any cancer cells that might remain after a tumor is surgically removed in a transurethral resection of a bladder tumor (TURBT).
Since the cancer has not spread to the bladder muscle or distant sites, a systemic treatment that circulates through the bloodstream is often unnecessary. This targeted method helps reduce the likelihood of the cancer returning or progressing. It is distinct from intravesical immunotherapy, such as using Bacillus Calmette-Guérin (BCG), which stimulates the body’s own immune system to attack cancer cells rather than using chemical agents.
The Treatment Procedure
A few hours before the scheduled appointment, you may be asked to limit your fluid intake. This is to ensure your bladder does not fill too quickly with urine, which would dilute the chemotherapy medication and make it harder to hold. Upon arrival, you may be asked to provide a urine sample to check for infections, as treatment is postponed if an infection is present.
The procedure starts with the insertion of a soft, flexible catheter through the urethra and into the bladder. Once the catheter is in place, the liquid chemotherapy drug is slowly instilled directly into the bladder. This process may be accompanied by a cool sensation. After the full dose has been delivered, the catheter is removed.
With the medication inside, the next step is to hold it within the bladder for one to two hours. This is known as the “dwell time,” and it allows the chemotherapy to be in direct contact with the cells lining the bladder. You may be instructed to change your position every 15 minutes to ensure the drug coats the entire inner surface, though the necessity of this is debated.
Once the dwell time is complete, you will empty your bladder to expel the chemotherapy medicine. After this, you can resume your normal activities, though you will be given specific instructions for the hours following the treatment.
Common Drugs and Treatment Schedules
The medications most frequently used for intravesical chemotherapy are Mitomycin C and Gemcitabine. Other drugs, such as Epirubicin, Docetaxel, and Valrubicin, may also be used. These drugs work by inhibiting the synthesis of DNA in rapidly dividing cancer cells. The choice of drug is based on the tumor’s characteristics and the patient’s overall health.
Treatment timelines are divided into two phases: induction and maintenance. The induction course is the initial, more intensive phase, which involves receiving the treatment once a week for approximately six weeks. This schedule is designed to eliminate any residual cancer cells after surgery.
Following a successful induction phase, a maintenance course may be recommended to reduce the risk of the cancer returning. This phase involves less frequent treatments, often administered monthly or every few months, and can continue for a year or longer. The specific schedule and duration are tailored to each individual.
Side Effects and Management
Because intravesical chemotherapy is delivered directly into the bladder, most side effects are localized to the urinary system. The drugs are not absorbed into the bloodstream in significant amounts, so systemic side effects like hair loss are avoided. The most common issues arise from inflammation of the bladder lining, a condition known as cystitis.
Symptoms of bladder irritation are frequent and can include a burning sensation during urination, an increased need to urinate, and a sense of urgency. Some people may also experience bladder spasms or notice a small amount of blood in their urine. In some cases, a rash may develop on the hands or feet. These side effects are mild and tend to resolve within a few days after each treatment session.
Safety precautions are necessary in the hours following treatment because the chemotherapy drug is expelled in the urine. For the first six to eight hours after voiding the medication, it is advisable for both men and women to sit on the toilet to prevent splashing. After urinating, you should wash your hands and genital area thoroughly with soap and water. Some guidelines recommend pouring a cup of household bleach into the toilet bowl and letting it sit for 15 minutes before flushing twice to neutralize any remaining drug.