Chemotherapy, or chemo, is a common treatment for people with bladder cancer. This therapy uses medicine to destroy cancer cells. If this is your first time having chemo, you might not know what to expect or how to prepare for it.

Read on to learn how chemo helps treat bladder cancer and what the process might be like for you.

1. Chemotherapy May Go Directly Into Your Bladder

Placing liquid chemo drugs directly into the bladder is called intravesical chemotherapy. A healthcare provider, usually a urologist (a doctor who specializes in conditions involving the urinary system), will insert a thin tube called a catheter into your bladder through your urethra (where urine exits the body). The liquid chemo is delivered into your bladder through this tube.

Intravesical therapy is usually given for two main reasons — either after a transurethral resection of bladder tumor (TURBT) or to treat non-muscle-invasive bladder cancer (NMIBC).

When used after a TURBT, intravesical chemotherapy is typically given as a single dose within 24 hours of the procedure. This helps destroy any remaining cancer cells and lowers the chance of the cancer coming back.

Intravesical chemo can also be used to treat NMIBC, a type of bladder cancer that hasn’t grown beyond the inner lining of the bladder to the muscle layer. People who have NMIBC with an intermediate or high risk of recurring (returning) may get intravesical chemo once a week for six weeks. After that, maintenance treatments may be done regularly for one to three years.

The most commonly used drugs for intravesical chemo are gemcitabine (Gemzar) and mitomycin (Mutamycin), but others may be used.

Although intravesical chemotherapy generally causes fewer side effects than chemo given through the bloodstream, it can still lead to some, such as:

• Bladder irritation
• A burning sensation in your bladder
• Hematuria (blood in the urine)

2. You May Receive Chemotherapy Before or After Surgery

Systemic chemotherapy is when chemo drugs are delivered into your bloodstream so they can travel throughout your entire body. This type of chemo can be given either before or after bladder cancer surgery.

Chemotherapy given before surgery is called neoadjuvant therapy. Chemo can help shrink the tumor, making it easier to remove and lowering the risk of cancer recurrence. Neoadjuvant chemo is often recommended to treat muscle-invasive bladder cancer.

Chemotherapy given after surgery is called adjuvant therapy. Its purpose is to destroy any remaining cancer cells and lower the risk of recurrence.

Chemo for bladder cancer often includes the drug cisplatin. However, several other chemo drugs may be used, either alone or along with cisplatin. Some of the most common chemo drugs used to treat bladder cancer include:

• Carboplatin
• Doxorubicin
• 5-fluorouracil
• Gemcitabine
• Methotrexate (Trexall)
• Mitomycin
• Paclitaxel
• Vinblastine

Your cancer care team will suggest a chemo regimen based on your overall health and the type and stage of your cancer. If you have a rare type of bladder cancer, such as squamous cell carcinoma or adenocarcinoma, you may need different types of chemo drugs.

3. Chemo May Be Your Main Bladder Cancer Treatment

If surgery isn’t a good option, chemo may be the main treatment, often combined with immunotherapy. Surgery may not be a good choice for people with advanced bladder cancer that has spread to other parts of the body, known as metastatic bladder cancer. Other serious health problems may also make surgery too risky.

Some people receive a combination of chemo drugs to treat metastatic bladder cancer. For example, gemcitabine may be combined with cisplatin or carboplatin, sometimes along with or followed by immunotherapy.

Systemic chemo for bladder cancer is typically given intravenously (into a vein). You’ll get chemo in cycles. Each cycle usually lasts two to four weeks, depending on the regimen. The number of chemo cycles also depends on the drugs being used. Most people receiving chemo for bladder cancer have three to six cycles.

4. Chemo Can Help Your Radiation Therapy Work Better

Radiation therapy destroys cancer cells using high-energy X-rays or radiation. If you undergo radiation therapy for bladder cancer, it can be more effective if you receive it with chemo. This combination is often referred to as chemoradiation. Chemo drugs commonly combined with radiation therapy include:

• Cisplatin
• Gemcitabine
• Mitomycin plus 5-fluorouracil

Chemoradiation can be used to treat advanced and metastatic bladder cancer. This therapy can also be for people who can’t or don’t want to have bladder removal surgery. When chemoradiation is paired with a TURBT, it’s called trimodality therapy. This type of treatment may allow people with stage 2 or 3 bladder cancer to preserve their bladder.

5. You May Be Given Chemotherapy at a Clinic or Hospital

Chemotherapy for bladder cancer is often given at a cancer clinic or a hospital. It can take several hours to get the full dose, depending on the type of chemo. It’s a good idea to bring something like a laptop, tablet, or book to help pass the time.

If you get chemo at a cancer clinic, you’ll likely be able to go home after your treatment. In some cases, you may need to stay in the hospital overnight or for a few days.

6. You May Get Immunotherapy That Uses Chemotherapy

A type of immunotherapy called an antibody-drug conjugate (ADC) links a monoclonal antibody with a chemo drug. A monoclonal antibody is a laboratory-made immune protein designed to target cancer cells, so the chemo drug gets delivered exactly where it needs to be.

Enfortumab vedotin (Padcev) is an example of an ADC that’s used to treat bladder cancer. If you have advanced bladder cancer, you may get this drug in combination with immunotherapy as a first treatment option.

7. You May Experience Side Effects From Chemo

Chemo drugs effectively target fast-growing cancer cells, but they can also harm fast-growing healthy cells, causing side effects. Some common chemo side effects include:

• Nausea and vomiting
• Decreased appetite
• Hair loss
• Sores in your mouth
• Diarrhea or constipation
• Tiredness
• Bruising or bleeding more easily than usual
• Increased risk of infections

Everyone responds to chemotherapy differently. Some people may not have any side effects, whereas others might. If you experience side effects, it’s important to tell your cancer care team right away. They can provide treatments, such as medications to prevent or manage nausea, and suggest lifestyle changes to help ease other chemo side effects.

Certain chemo drugs, such as cisplatin, paclitaxel, and docetaxel, can sometimes damage nerves, causing peripheral neuropathy. This condition may result in a burning or tingling feeling, weakness, or numbness in your hands and feet. If you develop these symptoms, your cancer care team can recommend treatments such as medications or physical therapy to help manage peripheral neuropathy.

Talk With Others Who Understand

MyBladderCancerTeam is the social network for people with bladder cancer and their loved ones. On MyBladderCancerTeam, members come together to ask questions, give advice, and share their stories with others who understand life with bladder cancer.

Have you had chemo for bladder cancer? Do you have any tips for managing chemo side effects? Share your experience in the comments below, or start a conversation by posting on your Activities page.