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Introduction
This page will give you an overview of intravesical thermo-chemotherapy, how it is given and side effects it may cause. Please read it carefully as it contains information that will help you to minimise any possible problems the treatment may cause. If you have any concerns or would like further information please do not hesitate to contact one of the urology team on the contact details listed below.
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.
A tumour is an abnormal growth of the body’s tissue cells and can be classified as benign (not cancer) or malignant (cancer). Benign tumours do not invade healthy tissue or spread around the body, they are not cancers. Malignant tumours have the ability to invade healthy tissue and to spread to other areas of the body.
The bladder is a hollow, muscular, balloon-like organ. It is in your lower pelvis and connected to your kidneys by two tubes called ureters. Urine passes down these tubes and is collected and stored in the bladder. Urine is passed out of the bladder through a tube like structure called the urethra.
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.
Your urology consultant has referred you for treatment of your superficial bladder cancer with intravesical thermo- chemotherapy using Mitomycin C. Mitomycin-C is a chemotherapy drug which works by killing cancer cells inside the bladder and therefore helps to prevent the tumours from recurring. The process of combining chemotherapy with heat is called thermo-chemotherapy. Recent evidence has shown that heating the chemotherapy drug when it is inside your bladder can help to increase its ability to kill cancer cells.
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.
Side effects usually start within three to four hours after treatment and last up to 24 hours. If you experience severe pain during or immediately after your treatment then please tell your clinical nurse specialist or doctor.
Common side effects:
- Some patients experience cystitis like symptoms such as pain or burning when passing urine. You many also notice some blood in your urine, don’t worry as this is normal, but it is best to mention it to your clinical nurse specialist. Drinking plenty of fluids will help with these symptoms. If symptoms persist for longer than three days then you should contact your GP.
- Very occasionally some patients may experience rashes on their hands, feet or genital area. Washing thoroughly with soap and water after passing urine will help to prevent this from happening, but you should tell your clinical nurse specialist if you develop these symptoms. On very rare occasions some patients may develop a body rash, please tell your clinical nurse specialist if you notice any type of rash on your body.
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 thermo-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 serious consequences for your health.
Your urology consultant will have discussed alternative treatment options with you. They may include repeated cystoscopies, radiotherapy, and surgical removal of the bladder with urinary diversion or bladder reconstruction. Such treatments may need to be reconsidered in the future, particularly if your cancer does not respond to the intravesical treatment or recurs. Please do ask your clinical nurse specialist or doctor if you require further information about these alternatives.
Your treatment will be carried out as a day procedure, which means that you will not need to stay in the hospital and can go home after your treatment has finished. You will be asked not to drink any fluids for 3 hours before your appointment. This is very important as it will make you more comfortable during the treatment and reduces the amount of urine that your body produces so that the chemotherapy isn’t diluted. If you feel thirsty, you can have small sips of water during this time.
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. Once your catheter is in place it will be connected to the treatment system and the chemotherapy drug will be slowly instilled into your bladder through the catheter. The system will then be switched on and will start to heat the drug and recirculate it around your bladder.
When the treatment system is switched on during the first few minutes you may notice a gentle warming sensation in your bladder area as the drug reaches its target temperature. You may at this time feel the urge to urinate, this is completely normal, and as you are catheterised you can relax and not worry about holding anything in.
The treatment will last for 60 minutes and during this time you will be asked to remain in a reclined position on a bed, you may like to take along a book, some magazines, crosswords or electronic device to help you relax and pass the time.
If you are feeling uncomfortable or have any concerns during treatment, your clinical nurse specialist will be available to support you.
After 60 minutes the treatment system will make a bleeping sound to signal that the treatment is complete.
At this time, the chemotherapy drug will be slowly drained out of your bladder before the catheter is gently removed. Although your bladder is now completely empty, you may feel like you need to urinate again at this point, this is normal as it is just your bladder readjusting to having the catheter removed.
You will be able to go home after your treatment when 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.
Please drink plenty of fluids (1-2 litres per day) in the first couple of days following your treatment, and also avoid caffeinated drinks such as tea, coffee and cola which can irritate your bladder. This helps to keep your urine diluted and makes recovery more comfortable. It also reduces the chances of developing a urinary tract infection.
Your urine may contain traces of chemotherapy for up to six hours following treatment, so it’s important to take some precautions during this time. It is recommended that both men and women sit down to use the toilet as this reduces the risk of spillage or splashing onto the skin. It is also recommended that you thoroughly wash your hands and genital area with soap and water after going to the toilet, as this reduces the risk of skin irritation. Taking medications such as paracetamol or ibuprofen can help you cope with any bladder side- effects. Please always read the instructions for use.
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 made up of two parts:
Induction regime:
- One dose of treatment, given every week for six weeks.
- Following this, a six week break with no treatment (to allow your bladder to recover).
- A cystoscopy (usually under general anaesthetic) is then performed to assess how well the treatment has worked. This 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).
- You will be seen in the general urology outpatient clinic around three weeks after your cystoscopy to discuss the results and ongoing plan.
Maintenance treatments:
- Following your initial cystoscopy, ongoing maintenance treatments may be advised.
- One dose of treatment is given every six to eight weeks to maintain the therapeutic effect. This is reviewed every six months by your urology consultant.
- Regular flexible cystoscopies (cystoscopy using local anaesthetic as an outpatient) every three to six months are needed to continue to inspect your bladder for any signs of cancer recurrence. If you are unsure when your flexible cystoscopy is due or you have not received an appointment letter, please contact the team.
The clinical nurse specialists are responsible for organising your treatment regime and administering the intravesical thermo-chemotherapy in the outpatient clinic. They provide a point of contact for you for ongoing support throughout your treatment (see contact details).
A cystoscopy under general anaesthetic will require a short stay in hospital (usually as a day case, but sometimes with an overnight stay).
A flexible cystoscopy is performed in the outpatient setting.
Sousa, A. Recirculant Hyperthermic Intravesical Chemotherapy (HIVEC) in Intermediate-High Risk Non Muscle Invasive Bladder Cancer. International Journal of Hyperthermia. 2016. Online. https://
Colombo, R. Salonia, A. Leib, Z. Pavon-Macaluso, M. & Engelstein, D. Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non- muscle-invasive bladder cancer (NMIBC). BJU Int. 107, 912–8 (2011).
Macmillan Cancer Support
Tel: 0808 808 0000 (Mon-Fri, 9am-8pm)
Action on Bladder Cancer (ABC-UK)
ABC is a UK based charity made up of healthcare professionals and patients who are dedicated purely to improving the lives of people with bladder cancer and raising awareness of the disease.
Fight Bladder Cancer
Fight Bladder Cancer is a UK based bladder cancer charity founded and run by bladder cancer survivors and their families.
The British Association of Urological Nurses (BAUN)
BAUN is a registered charity which aims to promote and maintain the highest standards in the practice and development of urological nursing and urological patient care.
The British Association of Urological Surgeons (BAUS)
BAUS is a registered charity which promotes the highest standards of practice in urology for the benefit of patients.
University College Hospital at Westmoreland Street
Switchboard: 0845 155 5000 or 020 3456 7890
Richard Weston, clinical nurse specialist
Tel: 0203 447 5134
Email: richard.
Kay Boyer, clinical nurse specialist
Tel: 07977 079333
Email: kay.
Hilary Baker, lead clinical nurse specialist
Email: hilary.
Superficial bladder cancer and renal service
Tel: 0203 447 9485
Email: uclh.
Flexible cystoscopy enquiries
Tel: 07903 870427 or 0203 447 7901
Email: uclh.
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.
Services
Page last updated: 13 August 2024
Review due: 31 August 2025