Chemotherapy is the use of anti-cancer medication to kill cancer cells in the body. Chemotherapy may be combined with surgery for localized bladder cancer and with surgery or radiation therapy for invasive disease. It is also the primary treatment option for disease that cannot be cured with surgery or radiation because it has spread beyond the bladder (metastatic disease or advanced disease).
Two types of chemotherapy are generally used to treat bladder cancer: intravesicular and systemic.
After surgeons remove a bladder tumor (transurethral resection), they commonly place chemotherapy in the patient’s bladder for one to two hours in the recovery room. This has been shown to reduce recurrence of bladder cancer. The chemotherapy (called intravesicular chemotherapy) is delivered through a urinary catheter and is drained from your bladder before you leave the recovery room.
This procedure is often used for patients whose cancer has not invaded the bladder. The goal is to try to kill any remaining cancer cells in the bladder. This therapy does not affect the rest of the body.
Depending on the features of your bladder cancer, your doctor may recommend intravesicular treatment with either chemotherapy or Bacillus calmette-guerin.
Systemic chemotherapy, given by infusion into a vein, is typically given in three-week cycles, usually for four to six cycles, with scans done every two to three cycles to check response.
Systemic chemotherapy can be used before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) to improve the chances for cure in patients with cancer that has a high risk of spreading. Systemic chemotherapy can also be combined with radiation therapy (chemoradiation) to make the radiation more effective.
In patients with locally advanced disease that is too large for surgery, chemotherapy may be used to make the cancerous tissue easier to remove surgically. In patients with metastatic disease, systemic chemotherapy may be used to control the disease and symptoms and to prolong life.
Your treatment is tailored to your health and goals. A variety of chemotherapy drugs (and drug combinations) are available. Your doctor will talk with you about your options. Most clinical studies for bladder cancer at Seattle Cancer Care Alliance and its founding organizations, Fred Hutchinson Cancer Research Center and UW Medicine, are testing different types of chemotherapy drugs.