Chemotherapy for bladder cancer can be administered intravesically (directly into the bladder) or systemically (injected into a vein or given by mouth).

Chemotherapy placed directly into the bladder (intravesical) only reaches cancer cells near the bladder lining rather than those in other organs or deep in the bladder wall. This treatment is used only for early-stage (superficial) bladder cancer. One of the main advantages of this method of chemotherapy is that the drug doesn't usually spread throughout the body. This means that there are fewer unwanted side effects, but there can be local bladder irritation.

In systemic chemotherapy, the drugs travel through the bloodstream to all parts of the body. In this treatment, the drugs can attack cancer cells that have already spread beyond the bladder to lymph nodes and other organs. While chemotherapy drugs kill cancer cells, they also damage some normal cells and this can lead to side effects. These side effects depend on the type of drugs used, the amount given, and the length of treatment.