Bladder and kidney cancer: into the bladder or through a vein

For bladder cancer, chemotherapy is given in two very different ways, and the difference matters. Intravesical treatment means the medicine is put directly into the bladder through a thin tube, held there for a short time and then passed out in the urine. It treats the lining of the bladder, is used for early cancers that have not grown into the bladder muscle, and hardly enters the bloodstream, so effects are mostly local. Systemic chemotherapy is given as a drip into a vein and travels around the whole body. It is used when cancer has grown into the bladder muscle, before or after an operation, together with radiotherapy, or when cancer has spread. Your team will be clear about which type you are having.

Kidney cancer is different again. The most common type, renal cell cancer, does not usually respond well to standard chemotherapy, so it is rarely used. Surgery is the main treatment for kidney cancer found early, and targeted medicines or immune treatments are usually used when it has spread or cannot be removed. Chemotherapy does play a role in some less common situations, such as cancer of the lining of the kidney drainage system and ureter, which behaves like bladder cancer, some rare kidney cancer types, and kidney tumours in children. Because of this, the word chemotherapy can mean quite different things for different people with a urinary cancer, and it is worth asking exactly what is planned.

Typical effects depend on the route. Bladder instillations can cause burning when passing urine, needing to pass urine often, bladder cramps and a little blood in the urine for a day or two. Chemotherapy through a vein can cause tiredness, feeling sick, a higher risk of infection, hair thinning, taste changes, numbness in the hands and feet, and effects on kidney function or hearing with some medicines. A urologist and medical oncologist plan treatment together, often with a radiation oncologist. This page explains the general picture and cannot describe your own plan, which depends on the type of cancer, how deeply it has grown, kidney function and your general health.

Into the bladder for early cancers

Treats the bladder lining with mainly local effects.

Through a vein for deeper cancers

Treats the whole body, before or after surgery, or with radiotherapy.

Rarely used for common kidney cancer

Targeted and immune medicines are used more often.

It cannot tell you which route or which treatment is right for you. That depends on your cancer type, how deeply it has grown and your health.

It also cannot predict how well treatment will work. Your team can explain what your results show.

Effects of bladder instillations

Most effects stay within the bladder. Burning when passing urine, needing to go often, cramps and slight bleeding are common for a day or two after each treatment. Drinking plenty of fluid once the medicine has been passed usually helps. Tell your team if symptoms last longer or seem to be getting worse.

Effects of chemotherapy through a vein

Chemotherapy through a vein affects the whole body. Tiredness, feeling sick, infection risk from low white cells, mouth soreness, hair thinning, numbness and changes to kidney function or hearing can occur with some medicines. Blood tests before each cycle check that it is safe to continue, and the team can treat most effects.

Precautions at home after an instillation

For a short time after bladder treatment, urine contains medicine. Sitting down to pass urine, flushing with the lid closed, washing hands and genital skin, and washing splashed clothes separately protect you and your family. Your nurse will explain how long these precautions are needed after each treatment.

Immune treatment into the bladder

Some early bladder cancers are treated with an immune-based liquid put into the bladder instead of chemotherapy. It is given in the same way but works by stirring up an immune reaction in the bladder lining. Flu-like symptoms can occur, and its precautions differ, so follow your team's specific instructions.

Chemotherapy before bladder removal

For cancer that has grown into the bladder muscle, chemotherapy through a vein is often recommended before the bladder is removed. It aims to shrink the cancer and treat cells that may have spread unseen. Your team will explain the planned number of cycles and how long the gap before surgery will be.

Chemoradiation to keep the bladder

Some people can keep their bladder by having radiotherapy combined with chemotherapy, often after as much of the tumour as possible has been removed through a telescope. This needs close follow-up with regular bladder checks. Whether it is suitable depends on the tumour and on how well the bladder works.

Why kidney cancer rarely uses chemotherapy

The common type of kidney cancer tends to resist standard chemotherapy medicines. Research over many years has led to targeted medicines and immune treatments that suit it better. If you have been told you have kidney cancer and have heard about chemotherapy, ask your team which treatment they actually recommend.

Targeted and immune medicines

For kidney cancer that has spread or cannot be removed, targeted tablets and immune treatments given by drip are commonly used, sometimes together. They have their own side effects, such as high blood pressure, skin and bowel changes, or inflammation of different organs, and need regular monitoring by your oncologist.

Cancer of the kidney lining and ureter

Cancer can start in the lining of the drainage system inside the kidney or in the ureter, the tube carrying urine to the bladder. It is the same kind of cancer as most bladder cancers and is treated in a similar way, including chemotherapy through a vein for some people.

Kidney function and treatment choice

Some chemotherapy medicines used for bladder cancer are cleared by the kidneys and need good kidney function. People who have had a kidney removed, or whose kidneys work less well, may be offered a different combination. Blood tests checking kidney function are repeated throughout treatment.

Regular bladder checks

After treatment for early bladder cancer, the inside of the bladder is checked regularly with a thin telescope, called cystoscopy. These checks look for any new growths, because bladder cancer can come back. Keeping every appointment is one of the most important parts of care.

Smoking and bladder cancer

Smoking is a major cause of bladder cancer and raises the chance of it coming back. Stopping smoking at any point helps, including during treatment. Your team can refer you to support services, and family members who smoke can help by not smoking around you.

Children with kidney tumours

Kidney tumours in young children are usually a different type from adult kidney cancer. Chemotherapy is an important part of their treatment, often alongside surgery and sometimes radiotherapy. These children are cared for by specialist paediatric cancer teams who explain each step clearly to parents and families.

What to do next

Ask your team whether your treatment goes into the bladder or into a vein, why that route was chosen, how many treatments are planned, which effects to expect, and what precautions you need at home afterwards.