Mitomycin C

How it works

It acts as a DNA alkylating and cross-linking agent, inhibiting DNA synthesis and proliferation of malignant urothelial cells.

Prescribing in practice

• It is a vesicant and tissue irritant; extravasation or instillation in the presence of bladder perforation can cause serious local injury, so avoid use where perforation is suspected.
• Local effects such as chemical cystitis and, with skin contact, dermatitis are common and require careful handling and patient hygiene advice.
• It must be prepared and administered by appropriately trained staff using cytotoxic precautions in line with the SPC.

Monitoring

Monitor for chemical cystitis and local toxicity after instillation, with cystoscopic surveillance to assess tumour recurrence over time.

Counselling the patient

• Empty your bladder after the instillation dwell time and wash the genital skin to limit irritation.
• Mild burning or frequency when passing urine is common for a short period; report severe or persistent symptoms.
• Follow the advice given about fluid intake and handling of urine after treatment.

Evidence & guidelines

Intravesical chemotherapy with mitomycin C is an established adjunct for non-muscle-invasive bladder cancer, supported by NICE guidance.