Intravesical treatment using Mitomycin C chemotherapy

This involves putting medicine directly into the bladder to treat a condition. This medicine is a chemotherapy drug called Mitomycin C. It is used to slow down or stop cancerous bladder tumours from growing inside the bladder.

In women this is a short tube which opens up in front of the vagina while in men it is much longer and passes through the prostate and penis.

The bladder is lined with a urine proof membrane called the urothelium which is made up of cells called transitional cells.

Most cancers in the bladder start in this membrane layer and are called transitional bladder cancers. Other, rarer, types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancer starts from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus.

Some bladder cancers form warty outgrowths or mushroom-like growths on the inside lining of the bladder. These are called papillary cancers. They have a short stem attached to the lining of the bladder.

Sometimes they go on to spread into the wall of the bladder.

If a bladder cancer only affects the inner lining of the bladder, it is known as a superficial cancer. If it has spread into the muscle wall of the bladder, it is called an invasive cancer.

Bladder cancer occurs most commonly in people between 50 and 70 years of age. It is the fourth most common cancer in men and eighth most common in women in the UK. You may also hear your cancer referred to as a neoplasm, growth, polyp or wart. If you are confused please feel free to ask a nurse or doctor to explain things to you.

Superficial bladder cancer affects the inner surface of the bladder only but has the ability to progress to more invasive disease. The aim of the treatment is to reduce the tendency for new and more invasive tumours to develop in the future.

Like all treatments, it comes with some possible side- effects (see below) and the risk of these should be considered against the risk of the bladder cancer for which the treatment is being given.

If you develop any of the following symptoms, you should attend an Accident and Emergency department immediately:

• Shortness of breath or difficulty breathing
• Facial swelling
• Severe abdominal (tummy) pain
• Cannot pass urine at all

• If you are a smoker, you should be aware that smoking seems to encourage the recurrence of bladder cancer.
• It may be preferable to talk to you employer ahead of time to schedule time off work during your treatment days.
• Sexually active patients should either refrain from sexual intercourse or use a condom for 48 hours following each treatment.
• Pregnant women should not receive chemotherapy. If you or your partner is planning to become pregnant then please consult your doctor.

Your urology consultant has recommended intravesical chemotherapy treatment because of your bladder cancer diagnosis and investigation findings. If you choose not to have this treatment your consultant will discuss any alternatives that may be suitable for your type of bladder cancer. However it is important to note that not having treatment could have more serious consequences for your health.

Your urology consultant will have discussed alternative treatment options with you. The most likely alternative treatment option would be to continue with bladder surveillance (regular cystoscopies). However, if your cancer continues to recur or progress, other intravesical treatments, radiotherapy or surgical removal of the bladder may need to be considered. Please do ask your clinical nurse specialist or doctor if you require further information about these alternatives.

If you suffer from constipation then you may wish to discuss this with your clinical nurse specialist as it can sometimes make treatment more uncomfortable.

It is important to tell your clinical nurse specialist before your treatment if you are taking diuretic medicines (water tablets) as you may be asked to take them at a different time on the day of your treatment.

If you feel unwell or are unable to attend your appointment for any reason then please contact the hospital and let them know as soon as possible.

Your clinical nurse specialist will discuss with you what will happen before, during and after your treatment, and you will be given the opportunity to ask any questions that you may have. This is part of the process of obtaining your informed consent to proceed. Before your first treatment you may be asked about any previous illnesses, drug allergies, operations or medications that you are taking, so it’s important to have this information ready with you at the time of your first appointment. If you have already started some treatment your nurse will discuss with you how you have been feeling since the last dose and whether you have experienced any side- effects (see above).

After making yourself comfortable on a treatment couch, the genital area will be cleaned with some antiseptic solution and an anaesthetic gel will be applied into your urethra (water passage) before a catheter (narrow tube) is passed through your urethra and into your bladder.

The chemotherapy drug will be slowly instilled into your bladder through the catheter. The catheter will then be removed and you will be asked to retain the drug (about 40mls of liquid) in your bladder for up to one hour. Very occasionally, people feel unable to hold the drug for one hour, so the catheter is left in whilst the drug is in the bladder.

You will be able to go home once the treatment has been administered and you feel ready. You may be asked to make a further clinic appointment at reception before you leave the department so that you can complete your course of treatments.

Treatment regimens can vary slightly between hospitals but all follow established guidelines for treatment which are based on evidence from clinical trials. The course of treatment at UCLH is as follows:

• One dose of treatment, given every week for six weeks.
• A cystoscopy (usually a flexible cystoscopy under local anaesthetic) is performed every 3-6 months to continue to monitor your bladder and check that there is no recurrence of your cancer. Your next cystoscopy will be planned during your treatment and you will receive an appointment letter in the post (please contact the team if you are concerned that you have not received your appointment).

The clinical nurse specialists are responsible for organising your treatment regime and administering the intravesical chemotherapy in the outpatient clinic. They provide a point of contact for you for ongoing support throughout your treatment (see contact details).

National Institute for Health and Care Excellence (2015) Bladder cancer: diagnosis and management, NICE guidelines [NG2]. https://www.nice.org.uk/guidance/NG2

Chou R et al (2017) Intravesical Therapy for the Treatment of Nonmuscle Invasive Bladder Cancer: A Systematic Review and Meta-Analysis, The Journal of Urology, May 2017, Vol 7, Issue 5, pp1189-1199. https://pubmed.ncbi.nlm.nih.gov/28027868

University College Hospital at Westmoreland Street 16 - 18 Westmoreland St, London, W1G 8PH

Intravesical treatment clinic

2nd floor outpatient’s department.

On arrival, please check in at the ground floor outpatient reception.