Intravesical Chemotherapy

• Intravesical chemotherapy involves direct drug delivery into the bladder via a catheter.
• It is primarily utilized for non-muscle-invasive bladder cancer to prevent recurrence and progression.
• The treatment works by locally exposing bladder lining cells to high concentrations of chemotherapy agents.
• Side effects are typically localized to the bladder, including irritation, urgency, and discomfort.
• This therapy significantly reduces the risk of bladder cancer recurrence, improving patient outcomes.

What is Intravesical Chemotherapy?

Intravesical chemotherapy refers to a medical procedure where anti-cancer medications are instilled directly into the bladder through a catheter. This localized treatment method is primarily employed for non-muscle-invasive bladder cancer (NMIBC), a condition where cancer cells are confined to the lining of the bladder and have not spread into the deeper muscle layers. The primary goal of this therapy is to eliminate any remaining cancer cells after surgical removal of tumors (transurethral resection of bladder tumor, or TURBT) and to prevent the cancer from recurring or progressing to a more aggressive stage. By delivering the drugs directly to the site of the disease, significantly higher concentrations of the medication can be achieved in the bladder wall with fewer systemic side effects compared to intravenous chemotherapy, which circulates throughout the entire body.

Mechanism and Application for Bladder Cancer

This treatment operates by exposing the bladder’s inner lining to chemotherapy drugs, such as mitomycin C, gemcitabine, or epirubicin, for a specific duration. These drugs directly target and destroy rapidly dividing cancer cells within the bladder. The bladder wall absorbs a small amount of the medication, allowing it to act locally on any residual tumor cells or microscopic disease. The direct application minimizes the amount of drug entering the bloodstream, thus significantly reducing systemic toxicity.

Intravesical chemotherapy for bladder cancer is a crucial adjuvant therapy, given after primary treatment (TURBT) to enhance its effectiveness and prevent recurrence. It is particularly effective for patients with NMIBC, which accounts for approximately 75% of all bladder cancer diagnoses. (Source: American Cancer Society, general statistics on bladder cancer types). The treatment schedule typically involves a series of instillations over several weeks or months, depending on the specific drug, cancer stage, and patient’s risk profile. The aim is to reduce the risk of recurrence, which can be as high as 50-70% for NMIBC if not adequately treated, and to prevent progression to muscle-invasive disease.

The procedure for intravesical chemotherapy generally follows these steps:

• Catheter Insertion: A thin, flexible tube (catheter) is gently inserted into the urethra and advanced into the bladder.
• Medication Delivery: The prescribed chemotherapy drug solution is slowly infused into the bladder through the catheter.
• Retention Period: The patient holds the solution in the bladder for a specified time, typically one to two hours, for adequate contact with the bladder lining.
• Drainage: After the retention period, the solution is drained from the bladder, and the catheter is carefully removed.

Intravesical Chemotherapy Side Effects

While Intravesical chemotherapy side effects are generally localized and less severe than those experienced with systemic chemotherapy, patients can still experience a range of adverse reactions due to the direct contact of the medication with the bladder and urinary tract tissues. These effects are usually temporary and manageable.

Common side effects include:

• Bladder irritation or spasms, leading to discomfort or a feeling of pressure.
• Increased frequency of urination or a strong, urgent need to urinate.
• Pain or burning sensation during urination (dysuria).
• Presence of blood in the urine (hematuria), usually mild and temporary.
• Mild flu-like symptoms, such as fatigue or low-grade fever, though these are less common.

Patients are typically provided with guidance on how to manage these symptoms, which often resolve within a few days after each treatment session. It is crucial for patients to communicate any severe, persistent, or unusual side effects to their healthcare team for prompt evaluation and potential adjustments to the treatment plan or the prescription of supportive medications. Serious complications, such as severe allergic reactions or urinary tract infections, are rare but possible.