Chemotherapy for bladder cancer

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The decision to recommend chemotherapy for bladder cancer and the choice of drugs depend on the characteristics of the individual patient, the personal experience of your doctor, current scientific evidence and logistics of the oncology clinic.

 

There are two main reasons chemotherapy is recommended for patients with bladder cancer:

The 3 most commonly used chemotherapy for bladder cancer regimens in the UK are:

MVAC
accelerated MVAC
Gemcitabine & cisplatin

Neoadjuvant chemotherapy

For bladder cancer this is usually reserved for situations were the tumour is advanced and broken through the wall of the bladder. It is hoped that giving chemotherapy first would shrink the tumour, allow smaller radiotherapy fields to be used, therefore giving less late side-effects (radiotherapy to the bladder). In some cases if the tumour is particularly bulky it could shrink the tumour down and make radiotherapy more effective. This technique is used in selected patients only because trials have shown it is not effective for everyone.

Palliative chemotherapy

The aim is not to cure, but to control or shrink the tumour especially if it is causing a specific symptom. The aim of this treatment is to improve the quality of life; therefore the side effects from the chemotherapy should not outweigh the benefits of shrinking the tumour. The response rates are in the order of 60%.

In these latter two categories, your oncologist would require a full re-assessment of your disease after two or three cycles, to check whether chemotherapy is working effectively. Re-assessment can be a combination of factors. First and foremost the patients symptoms should have improved, secondly there may be a lump or node on examination which should have reduced in size. Thirdly, response could be seen on an x-ray, CT or MRI scan. Finally some tumours secrete a chemical into the blood stream which can be measured (these include CEA & beta-HCG) - the levels of these reduce when a patient responds to chemotherapy. If there is no clear response, the chemotherapy regime could be stopped or changed.

Further general information Your doctors and specialist nurses are in an ideal position to give you relevant information on your disease and treatment as they know your individual circumstances. Cancerbackup has a help line (0808 800 1234) and a prize winning video available in English, Italian, Urdu, Bengali, Gujarati & Hindi explaining Radiotherapy & Chemotherapy. Cancernet.co.uk has over 500 pages describing cancer, its management, practical tips and tool which patients, their carers and their doctors have found helpful during the cancer journey.


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