Chemotherapy (chemo) is the use of drugs to treat cancer. When the drug is put directly into the area to be treated, it is called local chemotherapy. Intravesical therapy, where the drug is placed into the bladder, is a form of local chemo. Often, cancer is treated by giving the drugs in pill form, or by injection into a vein (IV) or muscle (IM). The drugs enter the bloodstream and circulate throughout the body. This is called systemic chemotherapy. Systemic chemotherapy can affect cancer cells far away from the main tumor. This makes it a good way to attack cancer cells that have spread from the bladder to lymph nodes and other organs.
 

Chemotherapy is sometimes given before surgery. This is done to try to shrink a large tumor so that it can be more easily removed by surgery. Giving chemo before surgery is known as neoadjuvant therapy.
 

Chemo can also be given after the tumor has been removed with surgery (or radiation). This is called adjuvant therapy. The goal of adjuvant therapy is to kill any cancer cells that remain after surgery (but are too small to see). This can lower the chance that the cancer will come back later.
 

Sometimes chemotherapy is given with radiation in order to help the radiation work better. Chemo can make the radiation more effective, but it also increases the radiation side effects.
 

Using a combination of chemotherapy drugs is more effective than using any single drug in treating bladder cancer. The combinations used most often for bladder cancer are:

• methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (called M-VAC)
• gemcitabine and cisplatin (called GemCIS)
• Carboplatin and a taxane (either paclitaxel/Taxol or docetaxel/Taxotere)

Other drugs sometimes used in systemic chemotherapy of bladder cancer include cyclophosphamide (Cytoxan), fluorouracil (5-FU), and mitomycin C.
 

Chemotherapy for bladder cancer can be hard, especially on patients who are older and have other serious medical conditions. Age itself, however, doesn't mean that you can't get chemo. Many older patients can tolerate chemotherapy and be helped by treatment. In the end, the decision to have chemotherapy is up to you and your doctor, and should be based on your basic health, available social support, and personal and family wishes.
 

Factors that help determine if a person will be helped by chemo include how well you are doing before treatment, how far the cancer has spread, and if certain blood test results are elevated.
 

There are other types of bladder cancer, including squamous cell carcinoma, adenocarcinoma, and small cell carcinoma. Chemotherapy for these rare types of bladder cancer may use different drugs than those listed above. Often, they are treated with the same drugs used to treat these same types of tumors when they are found elsewhere in the body.
 

Chemotherapy drugs kill cancer cells but also damage some normal cells, leading to some side effects. Side effects of chemo depend on the drugs used, the amount taken, and the length of treatment. Side effects tend to be worse when chemo and radiation are given at the same time. But most side effects are temporary, and will go away when treatment is stopped.
 

Common side effects seen with chemo include:

• nausea and vomiting,
• loss of appetite,
• loss of hair, and
• mouth sores.

Another common side effect is a low blood cell count. This is the effect of chemotherapy on the blood-producing cells of the bone marrow. This can result in:

• infection (because of a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets)
• fatigue (because of low red blood cell counts)

There are treatments that can prevent or lessen most of the immediate side effects. For example, several drugs (called antiemetics) can prevent or reduce nausea and vomiting. Also, a group of drugs called growth factors can help the bone marrow recover after chemotherapy and can treat problems resulting from low blood counts. Some growth factors make the bone marrow increase production of white blood cells. These drugs are sometimes used to prevent or treat low white blood cell counts in patients getting chemo.
 

Anemia (too few red blood cells) may be treated with red blood cell transfusions. In some patients whose chemotherapy is not expected to cure their cancer, anemia may be treated with erythropoietin, a growth factor that increases production of red blood cells. This drug may also signal cancer cells to grow. For that reason, its use is avoided in patients whose cancers may be able to be cured with chemotherapy.
 

Chemotherapy can also cause some long-term side effects. Some drugs can lead to premature menopause and infertility. The older a woman is when she receives chemotherapy, the more likely she will stop menstruating or lose her ability to become pregnant. Sometimes chemo drugs damage nerves (called neuropathy), leading to numbness or pain. Some of the drugs used in chemo have been linked to cases of leukemia later in life. This is very rare.
 

If you are getting chemotherapy, talk with your health care team about the drugs being used and what side effects to expect. Your doctor or nurse may know ways to prevent or help lessen them.