Mitomycin

What this treatment is and how it works

It damages and cross-links DNA (the genetic instructions inside cells), making it difficult for cancer cells to divide.

When it may be used

Your team may use this treatment in the following settings: Anal cancer, bladder cancer and selected other cancers. The choice depends on the exact diagnosis, stage, previous treatment, health and treatment aim. Treatment may aim to cure cancer, lower the risk of recurrence, or control cancer and symptoms, depending on the setting.

A listed use is not a claim that every brand is licensed for that use in every country. Your oncologist will explain why this treatment is appropriate for you.

Before treatment

Before starting, tell the team about previous cancer treatment, allergies, infection symptoms, heart, lung, kidney or liver disease, hearing or nerve problems, diabetes and all medicines you take. Discuss pregnancy, contraception and fertility. Ask for a written treatment calendar, supportive-medicine instructions and a 24-hour oncology contact number. Baseline blood tests usually include a full blood count and kidney and liver function; additional tests depend on the medicine and your health. Before chemotherapy that reaches the whole body, the team should check for current or past hepatitis B infection. If a test is positive, extra monitoring or antiviral treatment may be needed to prevent the virus becoming active again. The team will coordinate testing and treatment; do not delay urgent cancer treatment yourself.

How treatment is given and the schedule

Into a vein for systemic treatment, or directly into the bladder for selected bladder cancers. These routes have different instructions and risks.

Intravenous doses may be widely spaced because blood-count suppression can be delayed and prolonged. Bladder instillation courses follow a separate urology calendar.

The dose is calculated for your treatment and health. Rest periods, delays or dose changes may be needed. Do not change doses or treatment dates yourself, except to follow specific instructions to stop a medicine and seek help for warning symptoms. The team will give you a revised plan when needed.

During an infusion, tell the nurse immediately about pain, burning, swelling or leaking around the cannula or line. Do not massage the area or apply heat or ice unless the team instructs you.

Tests and monitoring during treatment

Blood counts are monitored for several weeks after systemic treatment. Kidney function and breathing symptoms are important. Before bladder treatment, staff assess urinary infection, bleeding and whether the bladder wall may be injured.

At each review, describe symptoms since the previous dose, including problems that have already settled. Blood tests can detect effects before you feel them. Your team may delay, reduce, omit or stop a medicine if results or symptoms make this necessary. The decision depends on the exact protocol; a normal result does not make new symptoms safe to ignore.

Side effects: what to expect

Frequency varies with the dose, schedule, cancer and other treatments. “Common or more frequent” is a practical grouping, not a single percentage for every patient. Some serious effects appear in more than one group because severity and frequency are different.

You are unlikely to have all of these effects. This is not an exhaustive list. Tell the team about any new or troublesome symptom, including one not mentioned here.

Common or more frequent side effects

Other reported side effects (frequency varies)

These effects may be common in some treatment settings, less common in others, or have no reliable frequency estimate. Their position here does not mean they are necessarily less frequent or less serious.

Mouth soreness, reduced appetite, fatigue and hair thinning may occur with systemic treatment. Lung inflammation is another recognised systemic risk and is explained below. Bladder instillation more often causes burning, urgency or frequent urination; whole-body effects are less usual but still possible.

Report these at review, or sooner if worsening. Use the urgent guidance for symptoms that affect breathing, drinking, urination, walking, consciousness or bleeding.

Important serious side effects, including rare effects

Serious does not always mean rare. Where reliable incidence is unavailable, no numerical frequency is assigned. The action to take matters even when the likelihood is uncertain.

A rare blood-vessel and kidney complication

Thrombotic microangiopathy, including haemolytic uraemic syndrome, can damage blood cells and kidneys. New swelling, reduced urine, unusual bruising, marked tiredness or breathlessness needs urgent assessment and blood tests.

Inflammation or injury in the lungs

A new cough, breathlessness, chest discomfort or falling exercise tolerance needs urgent oncology contact. Severe or rapidly worsening breathing difficulty is an emergency. Infection and other causes must also be considered.

Injury if medicine leaks outside the vein

Pain, burning, stinging, swelling or a colour change around the cannula or line requires immediate attention. Tell the nurse at once, or contact the unit urgently if it occurs after leaving. Do not massage the area or apply heat or ice unless instructed.

Significant kidney injury

Very little urine, persistent vomiting, worsening swelling or marked weakness needs urgent assessment. Kidney problems may first be detected on blood tests, which is why monitoring continues even when you feel well.

Practical advice for this treatment

For bladder instillation, follow the unit’s exact fluid, holding-time, toilet and urine-handling instructions; these depend on the product and procedure. Report fever, inability to pass urine, worsening pain or significant bleeding. Do not apply intravenous side-effect frequencies to bladder-only treatment.

Medicines, interactions and vaccinations

Give the oncology pharmacist a complete list of prescription medicines, over-the-counter products, vitamins, herbal and Ayurvedic remedies and supplements. Ask before starting anything new. Do not stop prescribed medicines, including anticoagulants or infection-prevention medicines, without a coordinated plan. Live vaccines are generally unsuitable while immunity is suppressed; discuss vaccine type and timing with the team. Non-live vaccines may be offered, although protection can be reduced. Follow any specific stop-and-call instructions for the cancer medicine on this page or in your written treatment plan.

Other kidney-, lung- or bone-marrow-affecting treatments need review. Previous radiotherapy and earlier mitomycin doses influence risk.

Pregnancy, fertility and breastfeeding

Chemotherapy can harm a developing baby and may affect fertility temporarily or permanently. Discuss sperm, egg or embryo storage before treatment when feasible. If you could become pregnant, or your partner could become pregnant, use effective contraception during treatment and for the drug-specific period afterwards. Ask for a written end date based on every medicine in your plan: the required period differs by product and can extend for months. Periods stopping does not guarantee infertility. Tell the team immediately about a suspected pregnancy. Do not breastfeed during treatment; restart only after the team confirms the interval for the exact medicine and formulation.

Everyday life

Gentle activity, regular meals and rest can help you cope. Prepare food hygienically and drink according to your individual fluid plan. Avoid smoking; ask whether alcohol is safe with your exact treatment and other medicines. Plan work, travel and driving around symptoms and monitoring visits. Do not drive if dizzy, sleepy, weak, visually affected or impaired by neuropathy. You can usually be close to family and friends: chemotherapy does not make you radioactive. Follow the unit’s instructions for handling urine, vomit, laundry and sexual precautions for the period it specifies.

When to contact the oncology team

Contact the oncology team the same day for persistent vomiting or diarrhoea, difficulty drinking, reduced urine, mouth pain affecting eating, new cough, jaundice, a painful or spreading rash, unusual bruising, worsening constipation or new nerve symptoms. Use the more urgent instructions for the particular symptom when given above. If the team cannot be reached and you are unwell, seek urgent medical care.

Write down your hospital’s daytime and out-of-hours numbers before treatment. CTI’s general contact details do not replace the emergency number provided by your treating hospital.

After treatment

Keep the planned blood tests and follow-up appointments after the last dose. Blood counts and immunity may take time to recover, and some effects can start or persist later. Contact the team about symptoms rather than waiting for a routine visit. Keep a treatment summary, including drug names, dates and any serious reactions, for future doctors. Response may be assessed with examination, scans or blood or marrow tests, depending on the cancer.

Frequently asked questions