Understanding Intravesical Chemotherapy
Intravesical chemotherapy involves the direct application of anti-cancer drugs into the bladder. The term “intravesical” means “within the bladder,” indicating local delivery. This method is primarily used to treat non-muscle invasive bladder cancer (NMIBC), where cancerous cells are confined to the inner lining of the bladder and have not spread into the deeper muscle layers.
The primary purpose of this localized treatment is to destroy any remaining cancer cells in the bladder following initial tumor removal, often through a procedure called transurethral resection of a bladder tumor (TURBT). By applying chemotherapy drugs directly to the bladder lining, the treatment effectively targets cancer cells while minimizing systemic side effects like nausea, vomiting, or hair loss, common with intravenous chemotherapy. Intravesical chemotherapy also plays a role in preventing the recurrence of NMIBC after initial surgery, and some drugs like mitomycin C and gemcitabine have shown efficacy in reducing recurrence rates.
Administering the Treatment
The administration of intravesical chemotherapy involves a series of specific steps to ensure the drug reaches the bladder effectively. Before the procedure, patients are typically advised to empty their bladder completely to allow for maximum concentration of the medication. It is also common practice to limit fluid intake for a few hours prior to treatment, and to avoid caffeinated beverages, as this can prevent the urine from diluting the drug and help the patient retain the medication.
A healthcare professional then inserts a thin, flexible tube, known as a catheter, through the urethra and into the bladder. The liquid chemotherapy drug is slowly instilled through this catheter directly into the bladder. Once the medication is in the bladder, the catheter may be removed, or in some cases, it may be clamped and left in place, depending on the specific protocol and the patient’s condition.
The medication is held in the bladder for a specific period, known as the “dwell time,” which typically ranges from one to two hours, often around 60 minutes, to allow the drug to interact with the bladder lining. After the dwell time, the patient empties their bladder, either by urinating naturally or by having the catheter removed or unclamped for drainage. Patients are usually advised to drink plenty of fluids for about 48 hours after treatment to help flush the drug from their system and maintain good bladder health. Precautions regarding hygiene and sexual activity, such as using condoms, are also recommended for a short period after treatment to prevent exposure to the chemotherapy agents present in body fluids.
Possible Side Effects
Because intravesical chemotherapy delivers medication directly to the bladder, the side effects are primarily localized, affecting the bladder itself rather than the entire body. Patients commonly experience bladder irritation, which can manifest as a burning sensation during urination or a feeling similar to a urinary tract infection. This irritation, often referred to as chemical cystitis, is a result of the drug’s direct contact with the bladder lining.
Other frequent local side effects include increased urinary urgency and frequency, meaning a stronger and more frequent need to urinate. Some individuals may also notice mild discomfort or pain during urination, or a small amount of blood or pink discoloration in their urine. These localized reactions are generally temporary and tend to subside within a few days following treatment. Less common but more significant reactions can involve bladder spasms or, in some instances, an infection, and any persistent or severe symptoms should be reported to a healthcare provider.
Expected Outcomes
Intravesical chemotherapy is a targeted treatment with specific goals for individuals with non-muscle invasive bladder cancer. The primary objective is to reduce the risk of cancer recurrence within the bladder lining and to prevent the disease from progressing to a more invasive stage. This treatment is often administered following the surgical removal of bladder tumors, aiming to eliminate any microscopic cancer cells that might remain.
The effectiveness of intravesical chemotherapy varies among individuals, but it is considered a standard component of care for many patients with NMIBC. It is frequently integrated into a broader treatment plan that may include other interventions. Regular follow-up surveillance, such as cystoscopies, is an important aspect of managing bladder cancer after intravesical chemotherapy to monitor for any signs of recurrence and to assess the long-term success of the treatment.