What To Expect During Bcg Treatment
First, make sure you havent had any fluids for four hours before the treatment. Right before you go into the treatment room your doctor or nurse will have you empty your bladder.
Youll lie on your back, and the medical professional will insert a catheter into your urethra and into your bladder, likely using some local numbing, and use this tube to infuse the treatment.
Once the treatment is infused, your doctor or nurse will remove the catheter. Theyll have you lie on your back, each side, and your stomach for 15 minutes each. The BCG mycobacteria needs to touch the bladder cancer cells to activate the immune system. Youll then be free to go but will need to hold off on peeing for another hour.
Verywell / Alex Dos Diaz
For at least six hours after your infusion, youll need to disinfect your pee to ensure none of the mycobacteria spread to anyone else. Pour an equal amount of bleach into the toilet after you pee and let it sit for 15 minutes before flushing.
Also, people with a penis who undergo BCG treatment should avoid sex for 48 hours to ensure they dont pass the mycobacteria to their partners.
You will likely need multiple BCG treatments. They may be given weekly for a few weeks, then less often for months or years to prevent cancer from coming back.
What Is Bcg Treatment
Bacillus Calmette-Guerin treatment is a type of intravesical immunotherapy. This liquid drug is made from a strain of Mycobacterium bovis the same bacterium used to create the tuberculosis vaccine. When used in medicine, Mycobacterium bovis is weakened to reduce harm to your body.
BCG treatment is usually given after TURBT , which is a bladder surgery to remove any visible cancer.
How Bcg Treatment Is Performed
BCG treatment is administered in a liquid form using a catheter inserted into the urethra so the BCG enters directly into the bladder.
Once the BCG has reached the bladder, the patient needs to avoid going to the bathroom for at least two hours in order for the BCG to have time to reach the cancer in the bladders lining.
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When Is Bcg Treatment Used
You may have BCG directly into your bladder after surgery to remove non-muscle-invasive bladder cancer. This type of surgery is called a transurethral resection of a bladder tumour .
This treatment helps prevent the cancer from coming back in the bladder lining. It also reduces the risk of the cancer becoming muscle-invasive. Doctors usually suggest this treatment if you have a high-risk bladder cancer, or sometimes if you have an intermediate-risk bladder cancer.
There is usually at least 2 weeks between the surgery to remove the cancer and the start of BCG treatment. This is to give your bladder enough time to heal from the surgery.
You usually have BCG treatment once a week for 6 weeks. This is sometimes called the induction course. You may be offered more BCG treatments. This is usually called maintenance treatment.
Treatment times vary. Your doctor will explain what is best for you.
Treating Complications Of Bcg Therapy
If you do experience a problem from BCG infection, you may need to receive targeted antibiotics, such as isoniazid and rifampin.
Complications of BCG therapy sometimes dont occur until years later. That can happen if the BCG bacteria that spread in the body become reactivated. These complications can sometimes be tricky to diagnose. Medical imaging might first make your clinician concerned about cancer or about another type of bacterial infection.
Make sure that all your medical care providers know that you have had BCG therapy. That will help guide their diagnostic process and ensure you get the best possible care. In some cases, your clinician will want a tissue sample from the involved area to make sure that the problem is from a BCG infection and not from some other source.
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How You Have It
BCG is a liquid. Your doctor or nurse puts the liquid into your bladder through a tube in the urethra . Usually, they then remove the catheter.
You must not pass urine for 2 hours. This gives the BCG time to be in contact with the lining of the bladder. Some hospitals may ask you to change position every now and again to make sure the drug reaches all parts of your bladder lining.
When you do pass urine, you need to be careful for 6 hours after the treatment because the vaccine contains bacteria. Men should sit down to pass urine to reduce the chance of splashing.
After you’ve been to the toilet, pour about half a pint of neat bleach into the toilet bowl and leave it for 15 minutes before flushing.
Wash your hands and genitals immediately with warm soapy water after you pass urine.
Side Effects Requiring Immediate Medical Attention
Along with its needed effects, bcg may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur while taking bcg:
More common
- painful urination
Rare
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Severe Pain And A Loss Of Appetite
My entire body literally shut down on me. I had major fever type symptoms, excruciating pain in all joints and a severe headache. I was unable to eat and just about managed to take on fluids over the two days. After discussions with my medical team who assured my wife it was a reaction to the BCG, I was admitted to hospital for a further three days unable to breathe properly, with severe kidney pains that could only be eased with morphine. A CT scan was taken that fortunately showed no abnormality in my kidneys, so I was eventually sent home with a course of antibiotics.
What Are Some Things I Need To Know Or Do While I Take This Drug
- Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
- If you have a latex allergy, talk with your doctor.
- Take extra care with your urine for the first 6 hours after getting this drug. Use the same toilet each time you use the bathroom at home. Sit down to urinate so your urine does not splash or spray.
- Before flushing, add an equal amount of bleach to the urine. Wait 15 minutes, then flush. Do this for the first 6 hours after BCG is given.
- It is fine to be around close contacts like household members, friends, and caregivers. However, do not allow anyone to come into contact with your urine.
- You may need a TB test before starting this drug.
- This drug may affect certain lab tests. Be sure your doctor and lab workers know you use this drug.
- Use birth control that you can trust to prevent pregnancy while taking this drug.
- Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.
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General Malaise And Fever
Again, these frequent side effects resolve mostly within 48 hours. Symptomatic antipyretics can be given when fever exceeds 38°C. Fever > 38.5°C for > 2 days needs close monitoring of the patient and consultation of infectious disease specialist in order to see if there are other causes of fever. While further diagnostic evaluation, prompt treatment with a minimum of two or more tuberculostatic agents is started.4 The duration of this therapy is badly defined and depends on further evolution of fever, malaise, and other findings at diagnostic exploration. Anyhow, further BCG is at least postponed, but with a high-risk tumor, the side effects should be weighed against the benefits.
Bcg Side Effects Mimicking A Urinary Tract Infection
The common theme here is that BCG side effects may mimic an Urinary Tract Infection. But the question is, how do you know?
I have had 3 BCG treatments followed by 3 Mitomycin treatments. I am now in maintenance of 3 BCG treatments. Last week was my first BCG treatment in over 2 months. Within hours I started feeling the urgency to urinate constantly. Within 48 hours, I had every symptom listed above with the exception of the fever, so I naturally thought I was having BCG side effects.
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Use Of Inactivated Bcg
The idea to inactivate BCG by heat, irradiation, or formaldehyde in order to prevent its side effects due to the living bacteria is already old, but recently was addressed again in preclinical studies.38,39 However, one is far from clinical application. Anyhow, one may expect that, if inactivated BCG keeps its therapeutic effect, the side effects due to the immune response will remain.
What Do I Need To Tell My Doctor Before I Take This Drug
- If you are allergic to this drug any part of this drug or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
- If you have any of these health problems: Active TB , blood in the urine, urinary tract infection , any infection, an illness with a fever, a weak immune system, or a disease that may cause a weak immune system like HIV.
- If you have or have ever had a BCG reaction.
- If you are getting other treatments like radiotherapy or chemo.
- If you are taking antibiotics, talk with doctor.
- If you are taking any drugs that suppress your immune system. There are many drugs that can do this. Ask your doctor or pharmacist if you are not sure.
- If you have had any of these in the past 14 days: A biopsy, a procedure called transurethral resection , or damage to the urinary tract after a catheter has been placed.
This is not a list of all drugs or health problems that interact with this drug.
Tell your doctor and pharmacist about all of your drugs and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.
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Side Effects After My 4th Treatment
Two days before my fifth session of BCG I was working out at the gym and found after 45 minutes that my body temperature was struggling to warm up. The tips of my fingers were also losing circulation, so I decided to cut my session short and go home. What was to follow after walking through my front door was 48 hours of unbelievable pain.
When Bcg Is Used
BCG helps prevent the cancer from coming back in the bladder lining, and also reduces the risk of it becoming invasive. Its usually given when there is a high risk that the cancer will come back and grow into the bladder muscle .
This may be in people who have:
- Carcinoma in situ – This cant usually be removed completely with surgery because its flat and often widespread in the bladder lining.
- High grade non invasive bladder cancers.
The urologist or cancer specialist will explain why BCG is the most appropriate treatment for you. There needs to be a gap of at least two weeks after youve had surgery before BCG treatment can be given.
Youll usually have your treatment with BCG weekly for six weeks, followed by a check of your bladder.
If the BCG treatment is working well, it can then be given weekly for 1-3 weeks every six months. This is called maintenance therapy and it can be given for up to three years.
Treatment times vary and your doctor will explain what is appropriate in your situation.
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What Other Drugs Will Affect Bcg
If you have an infection that must be treated with an antibiotic, you may need to stop receiving BCG for a short time. Antibiotics can make BCG less effective and should be avoided during your treatment with BCG. Follow your doctor’s instructions and be sure to tell any other doctor who treats you that you are receiving BCG.
Tell your doctor about all your other medicines, especially
Is There A Risk Of Bladder Cancer After Bcg Treatment
Like most cancers, bladder cancer can potentially return after treatment. Statistically, cancer will recur in up to 40% of people who receive BCG treatment. Its important to note, however, that even if the cancer comes back, it may not progress.
Low-grade bladder cancer usually doesnt spread to other areas of your body. But people who have low-grade bladder cancer have a higher risk of developing other low-grade cancers throughout their lifetime.
Less often, aggressive bladder cancer can develop after BCG treatment. If this happens, cystectomy is usually recommended.
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Mechanism Of Action Of Bcg
The mechanism of action of bacillus Calmette-Guérin therapy is incompletely understood. Some early studies purported that an immune response against BCG surface antigens cross-reacted with putative bladder tumor antigens, and this was proposed as the mechanism for the therapeutic effect of BCG however, multiple subsequent studies refute this claim.
The most likely mechanism of action of BCG immunotherapy involves a combination of its direct effect on tumor cells along with the patients immune response to the therapy. These effects are summarized by Kawai et al into three categories: infection of cancer cells, induction of immune response, and antitumor effects.
The infection of cancer cells is mediated by the glycoprotein fibronectin, which allows the internalization of BCG, breakdown of proteins, and cellular changes that trigger the immune system. This is similar to the immunologic reaction that occurs in patients with tuberculosis. This immune response comprises specific cellular changes including surface receptor changes and release of various cytokines. Interferon is considered to be an important part of this process and has been used in the past to determine appropriate response to treatment. The immune response crescendos to antitumor activity in which cells recognize the cancer cells, target them for destruction, and subsequently decrease cancer burden.
The overall response to BCG is limited if the patient is immunosuppressed.
Schedule And Technique Of Intravesical Bcg Instillation
South-west Oncology Group regimen was followed for instillations of BCG . This regimen was consisted of an induction therapy of 6 weekly instillations after 46 weeks of TURBT, followed by maintenance therapy of 3 weekly instillations given at 3 and 6 months, and then every 6 months for up to 3 years. Full written informed consent was obtained from each patient before starting BCG therapy.
After excluding urinary tract infection and haematuria, the instillation procedure was performed by urology resident in a standard manner. In case of adverse effects/complications, the decision to stop, continue or postpone treatment was taken by treating Urologist.
All patients were advised to report immediately to urology clinic if they develop symptoms of BCG adverse effect or infection.
BCG infection was confirmed via the detection of M. bovis by culture or M. tuberculosis complex by polymerase chain reaction assay or clinical, histopathologic and radiologic evidence of mycobacterial infection.
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I Learned To Take It Easy During Treatment
I’ve since finished my BCG treatment and I’m now awaiting a biopsy to establish how successful my treatment was. My hope is that Iâm given the all clear and allowed to move on with my life with just the little inconvenience of having to get myself checked every three months. It may well however turn out that I’m advised to undertake another course of BCG treatment. If that is the case I will now know for sure that it is very unlikely your body will cope with having major toxins put inside it. Cancer sufferers have to suffer for a reason, which is to ultimately rid our bodies of this disease. This pain will all be worth it if I’m able to achieve this, but either way I’m prepared to go through the suffering.
Prevention And Treatment Of Side Effects Of Immunotherapy For Bladder Cancer
- 1The First Clinical College, Gannan Medical University, Ganzhou, China
- 2Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- 3Institute of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
- 4Jiangxi Engineering Technology Research Center of Calculi Prevention, Gannan Medical University, Ganzhou, Jiangxi, China
Bladder cancer is one of the most important tumors of the genitourinary system, associated with high morbidity and mortality rates. Over the years, various antitumor treatments have been developed, and immunotherapy is one of the most effective methods. Immunotherapy aims to activate the bodys immune system to kill cancer cells. It has been established that immunotherapy drugs can be classified into non-targeted and targeted drugs depending on their site of action. Immunotherapy is reportedly effective for BC. Even though it can attack cancer cells, it can also cause the immune system to attack healthy cells, which can occur at any time during treatment and sometimes even after immunotherapy is stopped. Importantly, different types of immunotherapies can cause different side effects. Side effects may manifest themselves as signs or as symptoms. The prevention and treatment of side effects caused by immunotherapy is an important part of cancer patient management.
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Immunotherapy For Bladder Cancer
Some people with bladder cancer have immunotherapy. Immunotherapy helps to strengthen or restore the immune systems ability to fight cancer.
You may have immunotherapy to:
- kill bladder cancer cells
- stop bladder cancer cells from growing and spreading
- lower the risk that the cancer will come back
- help keep the cancer from coming back after it has already been treated
- control symptoms of bladder cancer
Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You may also receive other treatments.