Bladder cancer - Understanding intravesical treatment for bladder cancer

Overview

Once bladder cancer is diagnosed, your physician will design a treatment plan that may include specialized medications that are placed in your bladder. The term intravesical refers to liquid medications that are placed in your bladder. There are two classifications of intravesical medications that could be used, immunotherapy and chemotherapy. The type of medication, dosage and cycles of treatment are determined by your physician. The elected course of treatment depends on your type and degree of bladder cancer. The process of placing the medications in your bladder can help stop cancer from recurring, growing and spreading.

Intravesical instillation is done by inserting a catheter into the opening of the urethra, then into the bladder. When the catheter is in the bladder, the medication will be passed through the catheter into the bladder. The usual course of treatment is once a week for 3-6 weeks. The amount of treatment cycles is determined by your physician.

Immunotherapy

Bacillus Calmette-Guérin (BCG) is a live vaccine. When it is put in your bladder it causes inflammation. This inflammation stimulates the immune system and helps the body’s defense system fight bladder cancer.

Chemotherapy

Mitomycin-C, Valrubicin, Gemcitabine and Docetaxel are examples of chemotherapy medications. When it is put in your bladder, the chemotherapy medication will interfere with specific DNA processes. This interference and disruption will cause cell death and can help prevent bladder tumors from growing.

Frequently Asked Questions

What preparation is involved prior to treatment?

Limit your fluid intake the night before and up to your treatment. By reducing your fluid intake, it will help to keep the medication in the bladder for the necessary amount of time.
For Mitomycin-C installations, your doctor may ask you, to proceed with the alkalization of urine with 1.3 gm sodium bicarbonate the night before and the morning of the treatment to help improve the effectiveness. If your appointment is in the afternoon, please repeat 30 minutes prior to your procedure.
Tell your doctor or nurse if you feel feverish, have chills, cloudy urine, foul smelling urine, feel ill or are having trouble tolerating the treatments.

How long will the treatment take?

The actual bladder installation time takes only 15 minutes and you will be able to go home after it is complete, but you will need to keep the medication in the bladder for two hours. Please be advised that we recommend you go home after your treatment.

What happens during instillation?

You will be asked to leave a urine sample and empty your bladder.
A catheter will be passed into the bladder through the urethra. The medication will be instilled through the catheter into the bladder. This is known as intravesical instillation.
The catheter will be removed from the bladder after the instillation is completed.
It is extremely important you go home after your bladder is instilled with the medication. You must continue certain tasks after you leave the office.

What happens after the instillation (at home)?

The medication must be in your bladder for two hours after it is instilled.
To ensure the medication coats your entire bladder when you get home please position your body from side-to-side and back to front. Do every 15 minutes until the two-hour time is up.
After the medication has been in your bladder for two hours, sit down on the toilet to urinate and fully empty your bladder.
After urinating, pour two (2) cups of household bleach into the toilet, close the lid, wait 15-20 minutes, then flush the toilet. Wipe down the toilet with soap and water.
Wash your hands and genital areas thoroughly after you urinate, with soap and warm water.
Repeat steps 3-5 for 6 hours after each treatment.
Drink plenty of fluids after your instillation to flush your bladder.
If sexually active, wear a condom with intercourse while undergoing treatment.

Until your next treatment

You may experience the following symptoms for 1-2 days after your treatment:

Burning with urination
Blood and blood clots in your urine
Urgency and frequency
Flu like symptoms
Fatigue
Low grade fever (on the day of your treatment)

Contact the office during business hours, or 512-458-1121 after hours, if your symptoms do not improve, worsen or you develop large amounts of blood and clots, inability to empty your bladder, high grade fever, skin rash or hives. If you have any questions, please do not hesitate to call the office.