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Treating Bladder Cancer: Intravesical Therapy

Sometimes bladder cancer is treated by putting medicines that kill cancer cells right inside the bladder. This is called intravesical therapy. This treatment doesn't affect your whole body. It only damages the cancer cells in the lining of your bladder. It might be used:

  • Shortly after a type of surgery called TURBT (transurethral resection of bladder tumor) to kill any cancer cells left in the bladder.

  • To treat tumors that are small (stages 0 and I), slow-growing (low grade), and only in the lining of the bladder.

  • As a long-term treatment for cancer that's big and fast-growing. Or if there's more than 1 tumor.

  • After radiation and chemotherapy (chemo) for stage II tumors, if surgery can't be done.

Medicine in your bladder

This treatment is often done in a healthcare provider’s office. Or it may be done at an outpatient clinic. A soft, thin tube (catheter) is put into the urethra and passed through to the bladder. The catheter fills the bladder with the liquid medicine.

Most often, an immunotherapy medicine called BCG (Bacillus of Calmette and Guerin) is used. BCG is a type of bacteria. It boosts your immune system so that it kills the cancer cells. It has to come in contact with the cancer cells to work. This makes it a good choice for intravesical therapy.

A chemo medicine might be used if BCG doesn't work. Mitomycin and gemcitabine are the medicines most often used. The chemo might be heated before it's put in your bladder. This is called hyperthermic intravesical therapy. The heat might help the medicine get into the cancer cells.

Front view cross section of bladder with catheter inside delivering medication.Front view cross section of bladder with catheter inside delivering medication.

During treatment

After the medicine is put in, you'll need to keep it in your bladder for 2 hours. The catheter might be left in. It's used to take out the medicine after treatment. Then it's removed. Sometimes the catheter is taken out after the medicine is put in. Then you'll pee after the 2 hours are over. If BCG is used, you may need to pour bleach in the toilet after you pee. This kills any bacteria that may be left over.

Your treatment plan

There are many schedules used for intravesical therapy. Your healthcare provider will talk with you about the plan that's best for you.

  • BCG. The first cycle is often weekly for 6 to 8 weeks. During this time, you may be given antibiotics to help prevent infection. Then you may need follow-up treatments for up to 3 years. This is called maintenance BCG therapy. This helps keep the cancer from coming back.

  • Chemotherapy. These medicines are given weekly for 6 weeks. You might have 2 cycles. Treatment seldom lasts more than 1 year.

When all the treatments are done, you may have tests every few months. These are to check for cancer cells. 

Side effects of treatment

  • Intravesical BCG. This tends to cause flu-like symptoms for a few days after treatment. This includes fever, chills, aches, and severe tiredness (fatigue). You might see blood in your urine, need to pee right away (urgency), or have burning in your bladder. This is common.

  • Intravesical chemo. This can cause burning in your bladder and blood in your urine.

Risks and possible complications

Possible side effects include:

  • Bladder infection

  • Blood in the urine

  • Bladder irritation (burning, need to pee often, pain when peeing)

  • Flu-like symptoms, such as fever and chills

  • Scarring of the bladder (rare)

  • Blood infection with BCG (This is very rare, but can happen even years after treatment.)

When to call your healthcare provider

Call your healthcare provider right away if you:

  • Have a fever of 100.4°F (38°C) or higher, or as directed by your provider

Ask what other problems you should watch for and what you should do if you have them. Know how to get help any time, including after office hours, and on weekends and holidays. 

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Louise Cunningham RN BSN
Online Medical Reviewer: Todd Gersten MD
Date Last Reviewed: 12/1/2021
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