Bladder cancer

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Cystoscopy

Female urinary tract

Male urinary tract

• Methotrexate
• Vinblastine
• Doxorubicin
• Cyclophosphamide
• Paclitaxel
• Docetaxel
• Carboplatin
• Cisplatin
• Ifosfamide
• Gemcitabine

The combination of two of these drugs, gemcitabine and cisplatin, has been shown to be as effective with less side effects as an older regimen known as MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin). Many centers have replaced MVAC with this new combination. Paclitaxel and carboplatin is another effective combination that is frequently used.

A Foley catheter can be used to instill the medication directly into the bladder of patients with stage I disease. The catheter is removed immediately after the medication has been instilled. You are instructed to try to hold the medication in your bladder for at least two hours after treatment. Additionally, you may be asked to rotate from side to side every 15-30 minutes to completely expose the entire bladder wall to the medication.

Several different types of chemotherapy medications may be delivered directly into the bladder. They include:

• Thiotepa (Thioplex)
• Mitomycin-C (Mutamycin)
• Doxorubicin (Adriamycin)

Common side effects include bladder wall irritation and pain when urinating. Choice of a specific drug is usually based on the stage of the tumor.

IMMUNOTHERAPY

Bladder cancers are often treated by immunotherapy, in which a medication causes your own immune system to attack and kill the tumor cells. Immunotherapy for bladder cancer is usually performed using Bacille Calmette-Guerin (commonly known as BCG), which is a solution of genetically changed tuberculosis bacteria. Because they were genetically modified, these bacteria are not able to produce infection. BCG is administered through a Foley catheter directly into the bladder. Since BCG is a biological agent, special precautions must be taken during its handling and administration.

Potential side effects include bladder irritability, urinary frequency, urinary urgency, and painful urination. These are reported by 90% of the people treated with BCG. However, the symptoms usually resolve within a few days after treatment. Rare side effects include blood in the urine, malaise, nausea, chills, joint pain, and itching. Rarely, a systemic tuberculosis (TB) infection can develop, requiring treatment with anti-tuberculosis medication. Systemic infection is suspected if you develop an elevated temperature that lasts for more than one day.