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Friday, June 6, 2008

Chemotherapy for invasive bladder cancer

When it is given

Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. If the cancer has spread into the muscle of the bladder, or to other parts of the body, the chemotherapy drugs are given intravenously (into the vein).

This is done so that they can circulate in the bloodstream and reach the cancer cells anywhere in the body. Several drugs are given over a few days. The drugs are then repeated every few weeks for several months. The most commonly used intravenous drugs are cisplatin, carboplatin, methotrexate, vinblastine, gemcitabine (Gemzar®) and doxorubicin.

Intravenous chemotherapy may be given before surgery or radiotherapy to shrink the cancer and make these treatments more effective. It may also be used after surgery if there is a high risk of the cancer coming back or if tests show that the cancer has already spread to other parts of the body. Some research trials are using chemotherapy during radiotherapy treatment, to see whether this makes the treatments more effective.

Side effects

Chemotherapy drugs can cause side effects, but these can usually be well controlled with medicines.

Lowered resistance to infection Chemotherapy can reduce the production of white blood cells by the bone marrow, making you more prone to infection. Contact your doctor or the hospital straightaway if:

  • Your temperature goes above 38ºC (100.5ºF).
  • You suddenly feel ill (even with a normal temperature).

You will have a blood test before having more chemotherapy, to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if your blood count is still low.

Bruising or bleeding Chemotherapy can reduce the production of platelets, which help the blood to clot. Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) You may become anaemic. This may make you feel tired and breathless.

Nausea and vomiting Some chemotherapy drugs can make you feel sick or even be sick. Nausea and vomiting can be helped by taking anti sickness drugs (anti-emetics), which your doctor can prescribe.

Sore mouth Some chemotherapy drugs can make your mouth sore and may cause small ulcers. Regular mouthwashes are important and the nurses will show you how to do these properly.

Poor appetite If you don’t feel like eating during treatment, you could try replacing some meals with nutritious drinks or a soft diet. Our section on eating well has some useful tips on coping with eating problems.

Hair loss Some chemotherapy drugs may make your hair fall out. Hair loss can be very upsetting. However, if your hair does fall out, there are many ways of covering up, including wigs, hats or scarves. You may be entitled to a free wig from the National Health Service. Your doctor, or the nurse looking after you, will be able to arrange for a wig specialist to visit you. If your hair falls out, it should start to grow back within about 3–6 months of the end of treatment.

Chemotherapy affects people in different ways. Some people find they are able to lead a fairly normal life during their treatment, but many people become very tired and have to take things much more slowly. Just do as much as you feel like and try not to overdo it.

Although they may be hard to deal with at the time, these side effects will gradually disappear once your treatment is over.

Early menopause Chemotherapy may make some women have an early menopause. This can cause menopausal symptoms, which can include:

  • hot flushes
  • dry skin
  • dryness of the vagina
  • feeling low and anxious
  • being less interested in sex for a time.

Many of these symptoms can be eased by hormone creams or tablets, prescribed by your specialist. These replace the hormones that would have been produced by the ovaries. If dryness of the vagina is a problem, your GP or specialist can prescribe creams or Vagifem pessaries, or you can buy lubricating gels such as KY Jelly or Replens from the chemist. You or your partner can apply the gels or creams directly to the penis or vagina before or during sex.

Contraception It is not advisable to become pregnant or father a child while taking any of the chemotherapy drugs used to treat bladder cancer, as they may harm the developing foetus. It is important to use effective contraception during your treatment and for up to a year afterwards. You can discuss this with your doctor or specialist nurse.

Condoms should be used during sex within the first 48 hours after chemotherapy, to protect your partner from any of the drug that may be present in semen or vaginal fluid.

Our general information on chemotherapy discusses the treatment and its side effects in detail. There are also sections on individual drugs and their side effects.

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