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Bladder Cancer (cont.)

What Are the Roles of Chemotherapy, Immunotherapy, and Biological Therapy in the Treatment of Bladder Cancer?


Chemotherapy is the use of powerful drugs to kill cancer. In bladder cancer, chemotherapy may be given alone or with surgery or radiation therapy or both. It may be given before or after the other therapies. Chemotherapy can usually be given in a doctor's office or outpatient treatment clinic, but it may require a stay in the hospital

  • Stages Ta, T1, and CIS bladder cancer can be treated with intravesical chemotherapy, which means the placement of treatments directly into the bladder. After removal of the tumor, one or more liquid drugs are introduced into the bladder via a thin, plastic tube called a catheter. The drugs remain in the bladder for several hours and are then drained out, commonly with urination. This is often performed after the initial surgery to diagnose and remove, if possible, the bladder cancer to help kill any cancer cells that may be floating in the bladder after the surgery. Depending on the surgical findings and pathology, this treatment may be repeated once a week for several weeks.
  • Cancer that has invaded deeply into the bladder, lymph nodes, or other organs requires systemic or intravenous chemotherapy. The cancer-fighting drugs are injected into the bloodstream via a vein. This way, the drugs get into almost every part of the body and, ideally, can kill cancer cells wherever they are.

Chemotherapy side effects depend on which drugs you receive and how the drugs are given. Newer drugs to control some of these effects have been developed. Systemic chemotherapy is usually prescribed and overseen by a specialist called a medical oncologist.

  • The severity of side effects varies by person. For unknown reasons, some people tolerate chemotherapy much better than others.
  • Some of the most common side effects of systemic chemotherapy include nausea and vomiting, loss of appetite, hair loss, sores on the inside of the mouth or in the digestive tract, feeling tired or lacking energy (because of anemia, that is, low red blood cell count), increased susceptibility to infection (because of low white blood cell count), and easy bruising or bleeding (because of low platelet count). Numbness or tingling in the hands or feet can occur. Ask your oncologist about the specific effects you should expect.
  • These side effects are almost always temporary and go away when chemotherapy is over.
  • Multiple studies have demonstrated that intravesical chemotherapy is effective in decreasing the recurrence rate of superficial bladder cancers on a short-term basis.
  • Intravesical chemotherapy, such as Mitomycin, is often given as a single dose in the bladder immediately after the tumor has been removed with cystoscopy.
  • Intravesical chemotherapy can irritate the bladder or kidneys.
  • Intravesical chemotherapy is not effective against bladder cancer that has already penetrated into the muscular wall of the bladder or has spread to the lymph nodes or other organs.

Immunotherapy or Biological Therapy

Biological therapy takes advantage of the body's natural ability to fight cancer.

  • Your immune system forms substances called antibodies and recruits and direct specific cells called types of lymphocytes which can be found both in the blood and can move into the tissues to work against "invaders," such as abnormal cells (that is, cancer cells).
  • Sometimes, the immune system becomes overwhelmed by the very aggressive cancer cells.
  • Biological therapy, or immunotherapy, helps bolster the immune system in its fight against the cancer.
  • Biological therapy is typically given only in stages Ta, T1, and CIS bladder cancers.
  • One widely used immunotherapy or biological therapy in bladder cancer is intravesical BCG treatment.
  • A fluid containing BCG, an attenuated, or weakened cow TB (tuberculosis) bacteria (containing altered Mycobacterium), is introduced into the bladder through a thin catheter that has been passed through the urethra.
  • The Mycobacterium in the fluid stimulates the immune system to produce cancer-fighting substances.
  • The solution is held in the bladder for a few hours and then can be safely urinated out in the toilet, flushing and cleaning the toilet with bleach after. This treatment is repeated every week for 6 weeks and repeated at various times over several months or even longer in some cases. Researchers are still working to determine the best length of time for these treatments. Over time, the treatments may be required on a less frequent basis.
  • BCG may irritate the bladder and cause minor bleeding in the bladder. The bleeding is typically invisible in the urine. You may feel the need to urinate more often than usual or pain or burning when you urinate. Other side effects include nausea, low-grade fever, and chills. These are caused by stimulation of the immune system. These effects are almost always temporary.
  • Rarely, the use of intravesical BCG can be associated with an infection from the bacteria, and this may affect the prostate or may spread to other areas of the blood via the bloodstream. If you have a high fever after BCG treatment and/or persistent fevers, you should notify your physician.
Medically Reviewed by a Doctor on 11/23/2016
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