Intravesical therapy for bladder cancer

Published by Bupa's Health Information Team, November 2010.

This factsheet is for people who are having treatment for bladder cancer using mitomycin C or Bacille Calmette-Guérin (BCG) vaccine, or who would like information about it.

Mitomycin C is a chemotherapy medicine that destroys cancer cells. BCG is an immunotherapy that contains a weak form of the bacterium Mycobacterium bovis, which is also used to vaccinate against tuberculosis (TB). BCG works by encouraging the immune system to attack cancer cells.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About mitomycin C or BCG treatment

Mitomycin C and BCG are used to treat non-muscle-invasive bladder cancer (cancer of the bladder lining and not the muscle). Mitomycin C is usually given immediately after bladder surgery transurethral resection of bladder tumour, TURBT). BCG is usually given two weeks after bladder surgery to treat the more aggressive type of cancer of the bladder lining. Sometimes, mitomycin C or BCG are used alone to treat bladder cancer.

Your doctor will discuss with you which type of treatment is most suitable for you.

Mitomycin C or BCG is put inside the bladder and left in place for about two hours. This is called intravesical therapy. This type of therapy has fewer side-effects compared with medicines which are taken by mouth or are injected into a vein because the medicines stay in your bladder and don't pass into the rest of your body.

What are the alternatives?

Depending on your medical circumstances you may be offered other types of chemotherapy, or newer treatments such as the following.

• Photodynamic therapy. This involves using a chemotherapy medicine that is activated when light shines on it. The medicine is either placed directly into your bladder (through a catheter) or injected into a vein.
  
• Biological therapy. This involves using your body's natural substances (or medicines that block them) to treat cancer.

Preparing for mitomycin C or BCG treatment

Your doctor will discuss with you what will happen before, during and after your treatment, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the treatment. This will help you to be informed, so you can give your consent for the treatment to go ahead, which you may be asked to do by signing a consent form.

You will be asked not to drink for a few hours before mitomycin C or BCG treatment. This is to stop any urine collecting in your bladder during the treatment and diluting the medicines.

Mitomycin C or BCG treatment is usually a day-case procedure. This means you have the treatment and go home the same day. The treatment is usually given once a week for six weeks.

What happens during mitomycin C or BCG treatment

Your doctor will pass a thin tube (catheter) into your urethra (the tube that carries urine from the bladder to the outside) and into your bladder. He or she may apply a local anaesthetic gel around the entrance of your urethra beforehand to minimise any discomfort. You may feel the sensation of needing to pass urine as the catheter is fitted.

Mitomycin C or BCG will be injected through the catheter into your bladder. The catheter may be left in place but closed shut so that the solution doesn't escape, or it may be taken out.

You will be asked to rest on a bed for about two hours and to not to go to the toilet to pass urine during this time. This will give the medicines time to act on the lining of your bladder.

At the end of the treatment, if the catheter is in place, the fluid will be drained from your bladder and the catheter will be removed. If the catheter was taken out earlier, you will be asked to empty your bladder.

What to expect afterwards

You will usually be able to go home when you feel ready.

You may be given a date for a follow-up appointment.

Recovering from mitomycin C or BCG treatment

Follow your doctor's advice about returning to work and resuming your usual activities.

You should use a condom during sex for the first 48 hours after treatment. This will protect your partner from any medicines that may be present in semen or vaginal fluid. If you're having BCG treatment, it's best not to become pregnant or father a child while having it as the effect of the treatment on a developing baby isn't known. Use contraception during your treatment and for six weeks afterwards. Ask your doctor for more information.

Some of the medicine may be present in your urine for up to six hours after treatment. It's important to wipe the area around your urethra with a moistened tissue or flannel and wash your hands thoroughly with soap and water after passing urine. Sit to urinate and afterwards put bleach in the toilet and leave it for 15 minutes before flushing.

Drink plenty of clear fluids over the first couple of days to help flush your bladder and reduce your risk of getting a urinary infection.

Contact your doctor for advice if you have any of the following symptoms:

• a fever - a temperature higher than 37.5°C
  
• severe pain or pain that lasts for more than 48 hours
  
• a burning sensation when passing urine or smelly urine
  
• blood-stained urine
  
• difficulty passing urine
  
• feeling sick or vomiting
  
• a skin rash

You may have developed a reaction to the medicines or a urinary tract infection (UTI) and may need further treatment.

What are the risks?

Mitomycin C or BCG treatment is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of mitomycin or BCG treatment include:

• a burning sensation in your bladder
  
• feeling some pain or soreness when passing urine - this usually settles within two days

Complications

Complications are when problems occur during or after the procedure. Complications of mitomycin C or BCG treatment are uncommon, but can include:

• a urinary tract or bladder infection - you may need antibiotics to treat this
  
• a reaction to BCG - very rarely, the weakened bacteria in the BCG vaccine can cause an infection and you may need treatment with anti-tuberculosis medicines
  
• a reaction to mitomycin C - very rarely, the mitomycin C may pass into your bloodstream and affect your bone marrow or cause a skin rash

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.