Chemotherapy is the administration of cancer-fighting medication (cytotoxic drugs) to destroy cancer cells. It can be administered by itself or alongside surgery or radiotherapy.

Chemotherapy for bladder cancer can be given:

- Before surgery or radiotherapy to reduce the tumor's size and lower the risk of the cancer returning (neoadjuvant chemotherapy).

- In combination with radiotherapy to make the treatment more effective

- Sometimes, after surgery (adjuvant chemotherapy) if there is a high risk of the cancer coming back

- As stand-alone treatment for metastatic bladder cancer (palliative chemotherapy)

Often, several drugs are used in combination to treat bladder; some of these combinations are:

- gemcitabine and cisplatin (GC)

- methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC)

- cisplatin, methotrexate, and vinblastine (CMV)

- 5-FU and mitomycin

Patients may also receive other drug combinations or just one drug.

• How is the chemotherapy administered?

Chemotherapy is usually given on an outpatient basis, which means you can go home the same day. Chemotherapy is normally given as part of a course consisting of several treatment sessions (or cycles) and lasting for a few months.

You may be given chemotherapy drugs through a vein (intravenously) or in tablet form. Bladder cancer is normally treated with a combination of both.

Your chemotherapy nurse will give you the drugs intravenously using an injection or infusion (drip). The drugs are given through a small tube (line) in your arm, or a central line or PICC line. If you have a central line or a PICC line, your nurse will show you how to take care of it. These lines are designed to stay in place throughout the treatment.

• intravesical chemotherapy

After surgery, chemotherapy may be administered directly to the bladder to reduce the risk of the cancer returning; this is known as intravesical chemotherapy.

Chemotherapy acts by destroying cancer cells. When administered directly to the bladder, the drug comes into direct contact with the cancer cells on the lining of the bladder. Vesical chemotherapy is administered differently from when it is given intravenously, which is often used to treat invasive bladder cancer. Because it is administered locally, it doesn't cause certain side effects such as hair loss or nausea. And because the drugs is almost not absorbed by the blood it doesn't affect the rest of the body in the same way.

Most patients have just one intravesical chemotherapy treatment after surgery to remove the tumor.

If there is a low risk of the cancer coming back, more treatments will not be necessary; if the risk is moderate, a chemotherapy treatment will be given. Intermediate risk includes:

- Grade 1 or 2 cancer in stage Ta: a tumor that is larger than 3 cm / several tumors in the bladder / recurring tumors.

- Grade-2 cancer in stage T1: just one tumor that is smaller than 3 cm.

• How is it given?

Intravesical chemotherapy is usually given a few hours after surgery unless a high volume of blood in the urine (hematuria) has been observed, in which case the chemotherapy may be put off until the next day. It is administered in the hospital through a vesical catheter. If you need subsequent treatments, these may be given on an outpatient basis.

You may be limited as to the fluids you can have before chemotherapy is given so that your bladder is not full and there can be a higher drug concentration. If you take diuretics you will be asked to take these after your chemotherapy.

A vesical catheter is inserted so that the drugs may be administered through the catheter. The most commonly used drug is mitomycin-C.

You will be asked not to urinate for a period of time so that the drug can remain in your urine. In the 6 hours after the drug is administered you will be instructed to take certain precautions to prevent you and those around you from coming into contact with the drug. You will have to:

- Prevent urine from splashing out of the toilet.

- Carefully wash the genital area with soap and water after urinating.

- Put the toilet cover down and flush the toilet twice.

- Carefully wash your hands afterward

- Drink at least 2-3 liters of fluids a day for at least 48 hours after each treatment in order to help eliminate the drug.