Intravesical Chemotherapy for the Treatment of a Bladder Tumour
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- Kenneth Tobias Hawkins
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1 Intravesical Chemotherapy for the Treatment of a Bladder Tumour Patient Information
2 Introduction Your consultant has prescribed intravesical chemotherapy for the treatment of your bladder tumour. This booklet has been written to help you understand the treatment and for you to use as a reference in the future. It does not replace the discussion between you and your consultant but helps you understand more about what is discussed. If you have any questions or concerns, please do not hesitate to contact your urology clinical specialist nurse (also called a key worker). What is intravesical therapy? Intravesical means inside the bladder. Intravesical therapy is a chemotherapy agent prepared in pharmacy. The name of the chemotherapy drug you will be offered will either be: Mitomycin, Epirubicin or Doxyrubicin. These drugs all work in a similar way and have similar side effects. You will have the drug instilled into your bladder once a week for six weeks. Your appointments will be given to you by your clinical nurse specialist in urology. He/she will explain your treatment and answer your questions. What is superficial bladder cancer? You have recently had a procedure called a cystoscopy. During the procedure, your consultant found an abnormal area which has been either biopsied or removed. The results of this have shown that you have superficial bladder cancer. Superficial bladder cancer is a form of cancer which affects the inner lining of the bladder. It is important to know that the cancer has not grown into the muscle of the bladder, or outside the bladder wall. This means that your cancer is very treatable. Superficial bladder cancer has a risk of recurring. To reduce the likelihood of this happening, you have been prescribed a course of intravesical chemotherapy. When you come to Hospital At your first appointment you will be met by a nurse will explain your treatment and answer any of your questions. You will be asked to sign a consent form. You will then be taken into a treatment room and asked to lower your clothes below your waist. You will be asked to lie on your back on a treatment couch. 1
3 After cleansing with an antiseptic agent, a small tube called a catheter will be inserted into your urethra (water pipe) and will stay in place for up to one hour. The nurse will insert the intravesical therapy through the catheter into your bladder. You need to hold the treatment in your bladder for one hour. Once your catheter is removed, you will be given a date for your appointment the following week. You will then be able to go home. It is normal to see bits or clots in your urine during the treatment. These are scabs from the tumour breaking away from the bladder wall. You can eat normally before and after your treatment, however, you should reduce your fluid intake for two to four hours prior to treatment. You should take any of your regular medications as normal, unless otherwise instructed. You can drive yourself to the hospital and home again or travel on public transport. Benefits The benefits of the treatment are that it may reduce the risk of the tumour recurring. Risks The risks of not having the treatment are that the tumour may: Recur. Become more extensive. Cause further bleeding and discomfort. Alternatives An alternative intravesical therapeutic treatment is called Bacillus Calmette-Guérin (BCG) and is covered in a separate information leaflet called Your Treatment with Bacillus Calmette-Guérin (BCG). The choice of intravesical treatment is based on: The type of tumour and how advanced it is. Your previous history of bladder tumours and recurrences The condition of your bladder. This will be discussed with you before starting the treatment. 2
4 During treatment important information Because intravesical therapy contains a chemotherapy agent, you will need to take precautions when you pass urine following the treatment. Please follow these instructions carefully: You must wash your hands and genitalia thoroughly with soap and water each time you pass urine. If there is anyone at home on immuno-suppressive treatment, such as after a transplant, please tell the nurse before the treatment starts. If you are sexually active, you and your partner should use a condom whilst you are still receiving treatment. It is very important that you drink plenty of fluids over the first 24 hours after passing the treatment out from your bladder. This will help to reduce any irritation. You may find it easier to cope with holding the treatment if you restrict your fluid intake for two to four hours before each treatment. If you are due to have a flu vaccination whilst having this course of treatment, please discuss this with your clinical nurse specialist first. Side effects of intravesical therapy Side effects are unusual, but may occur as a result of infection or reaction to the drugs. It is important for you to be aware of them if they occur. If you experience any of these symptoms, contact your clinical nurse specialist immediately. Do not wait until your next visit to report them. Skin rash this resembles nettle rash and in severe cases, can result in blistering. It may occur towards the end of your treatment or even after your treatment has finished and usually occurs on the hands and feet. Increase in the number of times you pass urine. Burning or stinging when you pass urine. Fever or shivering. Offensive smelling or cloudy urine. After your course of treatment Following completion of your treatment we will arrange for you to have your bladder checked again with a small, flexible, fibre-optic telescope. This is called a cystoscopy. This will take place within six weeks from the end of the treatment. 3
5 If you need further help or advice, please do not hesitate to contact your clinical nurse specialist / key worker. Local Support Groups Please visit on our website for details of local support groups. Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: Fax: University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: Walsall Primary Care Trust Cancer Information & Support Services Challenge Building 4
6 Hatherton Street Walsall WS1 1YB Freephone: About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: June 2010 Review Date: June
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