Intravesical mitomycin C chemotherapy

What is the evidence base for this information?

This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrooke's. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.

What does the procedure involve?

Your consultant urologist has referred you for treatment of your superficial bladder cancer. The treatment involves instillations of liquid chemotherapy (mitomycin C) into the bladder through a catheter once a week for six weeks. This is recommended for intermediate risk (potentially aggressive, multiple or recurrent tumour) superficial cancer of the bladder. Superficial bladder cancer has the potential to recur. The aim of the treatment is to reduce the chances of recurrence over the next five years.

What are the alternatives to this procedure?

A surveillance approach, with repeated telescopic camera checks (cystoscopy) and treatment of tumours if the recur.

What should I expect before the procedure?

You will be asked to come to the hospital once a week for six weeks. You should limit your fluid input for six hours before each treatment.

Your first treatment will take up to 90 minutes. On arrival in the clinic, you will be asked to pass urine which will be tested to ensure that you do not have an infection in the urine. If you do, your treatment will need to be postponed for one week while you are treated with antibiotics.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• an artificial heart valve
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a prescription for warfarin, aspirin, rivaroxaban, dabigatran, apixaban, edoxaban or clopidogrel , ticagrelor or blood thinning medication
• a previous or current MRSA infection
• high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)

What happens during the procedure?

A fine rubber tube (called a catheter) will be passed into the bladder and the medication (approximately half a cup of fluid) will be given through it. The catheter will then be removed leaving the medication in the bladder. You will be asked not to pass urine for an hour to allow the medication to treat the bladder lining. During this time you should move around a little. This makes sure that the medication is spread around your entire bladder.

On your first visit, if you have not had mitomycin before, you will be asked to stay in the clinic while you hold the medication in your bladder, and you will be asked to pass urine before you go home. For the remaining treatments, if you live within 20 minutes of the hospital and have your own transport, you may be allowed to go home with the medication in your bladder and pass urine after one hour.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in 10)

• Some bladder discomfort after treatment
• Discoloured urine
• Blood in the urine
• Debris in the urine
• Frequency and urgency of urination which can persist for two to three days

Occasional (between one in 10 and one in 50)

• Skin rash
• Failure to complete the course of treatment due to bladder discomfort
• Urinary tract infection
• Stricture of the urethra (water pipe) following repeated use of a catheter

Rare (less than one in 50)

• Severe pain on instillation, persisting afterwards
• Allergic reaction to the instilled chemicals, requiring discontinuation of the treatment

What happens immediately after the procedure?

When you are advised that you can pass urine, you have to be careful that you don't get it on your skin. Men should sit down to pass urine, to reduce the chance of splashing. The urine contains some chemicals from the chemotherapy which could irritate your skin.

If you use the toilet then you must wash your genitals and hands immediately with warm soapy water to prevent the chemotherapy from irritating your skin.

What should I expect when I get home?

You should drink plenty of fluids (two to three litres) for the few days after the treatment. Some patients find that, for a few days after mitomycin C treatment, a glass of cranberry juice daily eases any bladder symptoms; cranberry juice, however, should not be used if you are taking warfarin.

If you think you have a urine infection (ie pain on passing urine, frequency or foul-smelling urine), it is important to contact your GP and get treatment with antibiotics.

Because this treatment is put directly into the bladder and not into the blood stream, you will not experience the side effects often associated with other cancer drug treatments. You should also inform your specialist nurse if this happens.

Are there any other important points?

You should wash your hands and genitals after you have passed urine and it is advisable to bring a wash bag with you to hospital when you come for the treatment.

You are advised not to have sexual intercourse for at least 24 hours after the treatment as this can cause some discomfort.

If you are a smoker, we will encourage you to stop since smoking seems to encourage recurrence of bladder cancer.

Driving after surgery

It is your responsibility to ensure that you are fit to drive following your treatment.

You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your treatment and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.

Privacy & Dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and/or specialist one to one care is required.

Is there any research being carried out in this field at Addenbrooke’s Hospital?

There is no specific research in this area at the moment.

Who can I contact for more help or information?

Oncology nurses

Uro-oncology nurse specialist
01223 586748

Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)
01223 274608

Prostate cancer nurse practitioner
01223 274608 or 01223 216897

Surgical care practitioner
01223 348590 or 01223 256157

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients)
01223 274608

Urology nurse practitioner (stoma care)
01223 349800

Urology nurse practitioner (stone disease)
07860 781828

Patient advice and liaison service (PALS)

Telephone: 01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email PALS

Mail: PALS, Box No 53
Addenbrooke's Hospital
Hills Road, Cambridge, CB2 2QQ

Chaplaincy and multi faith community

Telephone: 01223 217769
Email the chaplaincy

Mail: The Chaplaincy, Box No 105
Addenbrooke's Hospital
Hills Road, Cambridge, CB2 2QQ

MINICOM System ("type" system for the hard of hearing)

Telephone: 01223 217589

Access office (travel, parking and security information)

Telephone: 01223 596060

What should I do with this leaflet?

Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please do so below.

If you would like a copy of this leaflet to be filed in your hospital records for future reference, please let your urologist or specialist nurse know. If you do, however, decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

I have read this patient information leaflet and I accept the information it provides.

Signature……………………………….……………Date…………….………………….