Intravesical treatment using radio-frequency (RF) induced thermochemotherapy (Mitomycin C)

This involves putting medicine directly into the bladder to treat a condition. This medicine is a chemotherapy drug called Mitomycin C. It is used to slow down or stop cancerous bladder tumours from growing inside the bladder.

In women this is a short tube which opens up in front of the vagina while in men it is much longer and passes through the prostate and penis.

The bladder is lined with a urine proof membrane called the urothelium which is made up of cells called transitional cells.

Most cancers in the bladder start in this membrane layer and are called transitional bladder cancers. Other, rarer, types of bladder cancer are squamous cell cancer and adenocarcinoma. Squamous cell cancer starts from one of the types of cell in the bladder lining. Adenocarcinoma starts from glandular cells which produce mucus.

Some bladder cancers form warty outgrowths or mushroom-like growths on the inside lining of the bladder. These are called papillary cancers. They have a short stem attached to the lining of the bladder.

Sometimes they go on to spread into the wall of the bladder.

If a bladder cancer only affects the inner lining of the bladder, it is known as a superficial cancer. If it has spread into the muscle wall of the bladder, it is called an invasive cancer.

Bladder cancer occurs most commonly in people between 50 and 70 years of age. It is the fourth most common cancer in men and eighth most common in women in the UK. You may also hear your cancer referred to as a neoplasm, growth, polyp or wart. If you are confused please feel free to ask a nurse or doctor to explain things to you.

Superficial bladder cancer affects the inner surface of the bladder only but has the ability to progress to more invasive disease. The aim of the treatment is to reduce the tendency for new and more invasive tumours to develop in the future.

Like all treatments, it comes with some possible side- effects (see below) and the risk of these should be considered against the risk of the bladder cancer for which the treatment is being given.

Side effects usually start within three to four hours after treatment and last up to 24 hours. If you experience severe pain during or immediately after your treatment then please tell your clinical nurse specialist or doctor.

Common side effects:

• Some patients experience cystitis like symptoms such as pain or burning when passing urine. You many also notice some blood in your urine, don’t worry as this is normal, but it is best to mention it to your clinical nurse specialist. Drinking plenty of fluids will help with these symptoms. If symptoms persist for longer than three days then you should contact your GP.
• Very occasionally some patients may experience rashes on their hands, feet or genital area. Washing thoroughly with soap and water after passing urine will help to prevent this from happening, but you should tell your clinical nurse specialist if you develop these symptoms. On very rare occasions some patients may develop a body rash, please tell your clinical nurse specialist if you notice any type of rash on your body.

If you develop any of the following symptoms, you should attend an Accident and Emergency department immediately:

• Shortness of breath or difficulty breathing
• Facial swelling
• Severe abdominal (tummy) pain
• Cannot pass urine at all

• If you are a smoker, you should be aware that smoking seems to encourage the recurrence of bladder cancer.
• It may be preferable to talk to you employer ahead of time to schedule time off work during your treatment days.
• Sexually active patients should either refrain from sexual intercourse or use a condom for 48 hours following each treatment.
• Pregnant women should not receive chemotherapy. If you or your partner is planning to become pregnant then please consult your doctor.

Your urology consultant has recommended intravesical RF induced thermochemotherapy treatment because of your bladder cancer diagnosis and investigation findings. If you choose not to have this treatment your consultant will discuss any alternatives that may be suitable for your type of bladder cancer. However it is important to note that not having treatment could have serious consequences for your health.

Your urology consultant will have discussed alternative treatment options with you. They may include repeated cystoscopies, radiotherapy, and surgical removal of the bladder with urinary diversion or bladder reconstruction. Such treatments may need to be reconsidered in the future, particularly if your cancer does not respond to the intravesical treatment or recurs. Please do ask your clinical nurse specialist or doctor if you require further information about these alternatives.

Your treatment will be carried out as a day procedure, which means that you will not need to stay in the hospital and can go home after your treatment has finished.

We would recommend the following preparation to help you feel more comfortable and reduce the amount of urine you produce during the treatment:

• Do not drink any fluids for 3 hours before your appointment (if you feel thirsty during this time you can have a sip of water).
• Do not drink any caffeinated drinks such as tea, coffee, cola or any alcohol on the day of your appointment.
• Try not to empty your bladder for 1-2 hours before your appointment (try to come with a fuller bladder). If you find this difficult and need to pass urine, don’t worry, it will not affect the treatment overall. Please do not pass urine on arrival for your treatment.

It is important to tell your clinical nurse specialist before your treatment if you are taking diuretic medicines (water tablets) as you may be asked to take them at a different time on the day of your treatment.

If you feel unwell or are unable to attend your appointment for any reason, please let the team know as soon as possible.

Maintenance treatments:

• Following your initial cystoscopy, ongoing maintenance treatments may be advised.
• One dose of treatment is given every six to eight weeks to maintain the therapeutic effect. This is reviewed every six months by your urology consultant.
• Regular flexible cystoscopies (cystoscopy using local anaesthetic as an outpatient) every three to six months are needed to continue to inspect your bladder for any signs of cancer recurrence. If you are unsure when your flexible cystoscopy is due or you have not received an appointment letter, please contact the team.

The clinical nurse specialists are responsible for organising your treatment regime and administering the intravesical RF induced thermochemotherapy in the outpatient clinic. They provide a point of contact for you for ongoing support throughout your treatment (see contact details).

A cystoscopy under general anaesthetic will require a short stay in hospital (usually as a day case, but sometimes with an overnight stay).

A flexible cystoscopy is performed in the outpatient setting.

• Campodonico F, Di Stasi S, Lev GM et al (2017) Intravesical chemotherapy and chemohyperthermia in non-muscle invasive bladder cancer; an overview on drug administration technologies and pharmacokinetics, Current drug metabolism, 2017, 18. https://pubmed.ncbi.nlm.nih.gov/28460622
• Colombo R, Salonia A, Leib Z, Pavon-Macaluso, M. & Engelstein, D (2011) Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC). BJU Int. 107, 912–8 (2011).

University College Hospital at Westmoreland Street 16 - 18 Westmoreland St, London, W1G 8PH

Intravesical treatment clinic

2nd floor outpatient’s department.

On arrival, please check in at the ground floor outpatient reception.