What Happens During Treatment
A urinary catheter is inserted through your urethra and into your bladder. Then the BCG solution is injected into the catheter. The catheter is clamped off so the solution stays in your bladder. Some doctors may remove the catheter at this time.
You have to hold the medicine in your bladder. Youll be instructed to lie on your back and to roll from side to side to make sure the solution reaches your entire bladder.
After about two hours, the catheter is unclamped so the fluid can be drained. If the catheter was already removed, youll be asked to empty your bladder at this time.
Radiotherapy With A Radiosensitiser
Radiotherapy is given by a machine that beams the radiation at the bladder . Sessions are usually given on a daily basis for 5 days a week over the course of 4 to 7 weeks. Each session lasts for about 10 to 15 minutes.
A medicine called a radiosensitiser should also be given alongside radiotherapy for muscle-invasive bladder cancer. This medicine affects the cells of a tumour, to enhance the effect of radiotherapy. It has a much smaller effect on normal tissue.
As well as destroying cancerous cells, radiotherapy can also damage healthy cells, which means it can cause a number of side effects. These include:
- tightening of the vagina , which can make having sex painful
- erectile dysfunction
- difficulty passing urine
Most of these side effects should pass a few weeks after your treatment finishes, although there’s a small chance they’ll be permanent.
Having radiotherapy directed at your pelvis usually means you’ll be infertile .
After having radiotherapy for bladder cancer, you should be offered follow-up appointments every 3 months for the first 2 years, then every 6 months for the next 2 years, and every year after that. At these appointments, your bladder will be checked using a cystoscopy.
You may also be offered CT scans of your chest, abdomen and pelvis after 6 months, 1 year and 2 years. A CT scan of your urinary tract may be offered every year for 5 years.
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What Conditions Are Treated With Bcg Treatment
BCG treatment is used to address early-stage bladder cancer. This includes bladder cancers that havent invaded your bladder wall muscle, such as carcinoma in situ bladder cancers and non-muscle invasive bladder cancers . BCG treatment isnt effective against bladder cancer that has metastasized .
Clinical trials are currently underway to explore BCG treatment for fibromyalgia and diabetes. Experts believe that BCG treatment may increase cytokines , which could potentially benefit people with these conditions. More research is needed in these areas, though.
Are There Any Possible Effects From The Treatment
9out of 10 people having BCG will develop some side effects these usually beginwithin 3-4 hours after treatment and may last 1-3 days.
You should tell your doctorat your next appointment if you have any of these symptoms.
- Somebladder discomfort – an irritation rather like a urine infection.
- Flu-likesymptoms which can last for 1-3 days after each treatment.
- Wantingto pass urine more often than usual or more urgently, which can last for two tothree days.
- Failureto complete the course of treatment due to discomfort in the bladder.
- Bloodor debris in the urine.
Drinking2 litres of fluid daily, unless advised otherwise, and avoiding tea/coffee for24 hours after treatment will help flush any remaining drug out of the bladderand may ease the above symptoms.
- Narrowing of the urethra following repeated use of a catheter.
- Inflammationwhich can affect various parts of the body .
- Persistentor severe pain after treatment, sometimes leading to removal of the bladder.
- Generalisedand possibly serious infection with the BCG bacteria needing treatment inhospital with powerful antibiotics. This is not TB and there is no risk ofcatching TB from the treatment.
Veryrarely – less than 1 person in every 100 – may experience more serious treatmenteffects.
Contact your GP/Nurse immediately if you have anyof the following:
- Urineis cloudy/offensive smelling
- HighTemperature over 38°C for 48 hours
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Adverse Effects Of Bcg
Common adverse effects include cystitis, dysuria, malaise, fatigue, and a low fever . These can be managed by NSAIDS, phenazopyridine, and anticholinergics. If symptoms become intense or last longer than 24 hours, consider either delaying additional instillations until symptoms improve or reducing the dose.
In a review including 2602 patients treated with intravesical BCG instillation , the most common side effects were fever > 103ºF, hematuria, granulomatous prostatitis, pneumonitis and/or hepatitis, arthralgia, epididymitis, sepsis, rash, ureteral obstruction, bladder contracture, renal abscess, and cytopenia.
Early-onset BCG infection often presents as systemic manifestations. In contrast, delayed-onset infection presents as localized disease. Manifestations are as follows:
- Systemic manifestations occur when BCG disseminates outside of the genitourinary tract. They include sepsis syndrome, pulmonary issues from dyspnea, granulomatous hepatitis, osteomyelitis, reactive arthritis, monoarthritis, psoas abscess, and vascular complications due to mycotic aneurysms.
- Localized manifestations include cystitis, bladder contracture, granulomatous prostatitis, prostate abscess, epididymo-orchitis, testicular abscess, pyelonephritis, renal abscess, urethral stricture, and balanitis.
The AUA has noted the following with regard to BCG2:
Contributor Information and Disclosures
Fellow in Urologic Oncology and Minimally Invasive Surgery, University of Chicago Medical Center
Is There Any Preparation Involved
Its important that you follow your doctors instructions for what to do before and after the procedure. Tell your doctor about all the medications you take. Certain immunosuppressants, antimicrobial therapies, and radiation therapies can interfere with BCG treatment.
Youll be advised to limit your fluid intake for four hours prior to the procedure. You might be told to avoid caffeine for a few hours longer than that, because its a diuretic and could make things more difficult.
Youll be asked to urinate just before the procedure so youll be able to hold the medication in your bladder for several hours.
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When Do Doctors Use Bcg
Doctors most commonly use BCG to treat superficial bladder cancer. The vaccine stimulates the immune system to attack cancer cells in the bladder. It can be used with intravesical chemotherapy for advanced stages of bladder cancer.
It is not recommended for those who have weakened immune systems. While BCG treatment for bladder cancer can be effective, it is not a cure. It can help prevent cancer from recurring.
Treatments For Early Stage Bladder Cancer
The following are treatment options for bladder cancer. Early stage bladder cancer is only in the inner lining or thin connective tissue layer of the bladder . This includes stage 0a, stage 0is and stage 1 bladder cancers. Your healthcare team will suggest treatments based on the . They will work with you to develop a treatment plan.
Sometimes bladder cancer comes back after it has been treated or initial treatments dont work. If the cancer is still non-invasive or non-muscle invasive, the following treatments can be used.
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Treatment Of Bladder Cancer By Stage
Most of the time, treatment of bladder cancer is based on the tumors clinical stage when it’s first diagnosed. This includes how deep it’s thought to have grown into the bladder wall and whether it has spread beyond the bladder. Other factors, such as the size of the tumor, how fast the cancer cells are growing , and a persons overall health and preferences, also affect treatment options.
Treating Stage 0 Bladder Cancer
Stage 0 bladder cancer includes non-invasive papillary carcinoma and flat non-invasive carcinoma . In either case, the cancer is only in the inner lining layer of the bladder. It has not invaded the bladder wall.
This early stage of bladder cancer is most often treated with transurethral resection with fulguration followed by intravesical therapy within 24 hours.
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How Can Bladder Cancer Be Unresponsive To Bcg
BCG does not work for everyone who tries it. Treatment effectiveness varies from person to person. About one-third of people with NMIBC who do BCG therapy do not respond to it. The reasons for this are not fully understood.2
BCG unresponsiveness is defined by at least one of the following:2
Treating Stage I Bladder Cancer
Stage I bladder cancers have grown into the connective tissue layer of the bladder wall , but have not reached the muscle layer.
Transurethral resection with fulguration is usually the first treatment for these cancers. But it’s done to help determine the extent of the cancer rather than to try to cure it. If no other treatment is given, many people will later get a new bladder cancer, which often will be more advanced. This is more likely to happen if the first cancer is high-grade .
Even if the cancer is found to be low grade , a second TURBT is often recommended several weeks later. If the doctor then feels that all of the cancer has been removed, intravesical BCG or intravesical chemo is usually given. If all of the cancer wasn’t removed, options are intravesical BCG or cystectomy .
If the cancer is high grade, if many tumors are present, or if the tumor is very large when it’s first found, radical cystectomy may be recommended.
For people who arent healthy enough for a cystectomy, radiation therapy might be an option, but the chances for cure are not as good.
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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.
How Should I Prepare For Bcg Treatment For Bladder Cancer
Prior to BCG treatment, your healthcare provider will give you a list of specific guidelines to help you prepare. In general, you should avoid caffeinated beverages and diuretics for four hours before your appointment. When you arrive for your procedure, you should pee to ensure that your bladder is empty.
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How Bcg Is Administered
You will be asked to pass urine to make sure the bladder is empty.
You will then have a tube put in the urethra. The BCG is a liquid and will pass through this tube directly into thebladder.
The catheter is then usuallyremoved. Sometimes it may be left in andclamped. You shouldn’t pass urine for 2hours. You can walk about whilst the BCG is in your bladder. When you do pass urine, you will need to becareful for 6 hours after the treatment as the vaccine contains live TB.
Thetreatment session will take a little over 2 hours after which you will be ableto go home. You should feel well enough to drive yourself home after thetreatment.
After yourfirst few treatments, if you live within easy reach of the hospital and haveyour own transport, you may be allowed to go home with the medication in yourbladder and pass urine at home after two hours.
If you areelderly or have mobility issues, you may wish to arrange for a friend orrelative to accompany/collect you. You will be ableto carry out your normal activities after treatment. There are no restrictionson driving, work etc.
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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Bladder Cancer And Its Symptoms
Bladder cancer is an invasive type of cancer that develops within the bladder. It affects the cells in the bladder and progresses slowly. When the cancerous cells spread to other parts of the body, it is referred to as metastasized bladder cancer.
The symptoms of bladder cancer are often vague or non-existent and so it can be hard to detect or diagnose. The symptoms depend on where the cancer is in the bladder i.e., whether it is contained only in the bladder or it has spread to other parts of the body.
The signs you should look out for include frequent urination, blood in the urine, pressure in your bladder and pain when urinating.
When cancer spreads out of the bladder, it is called metastasis. The most common place for metastasis of bladder cancer is in the bones, lymph nodes, liver and lungs. The symptoms of bladder cancer from its initial stage to the advanced stage include dizziness, difficulty in breathing, rashes, joint pain and in rare cases fever.
How Bcg Therapy Is Done
BCG as an immunotherapy for cancer is given through a catheter into the bladder, never intravenously or as an injection. This is usually done in an outpatient setting. The professionals there will assemble the BCG so that it can be safely administered.
Your clinician will give you specific instructions about how you need to prepare ahead of time. You may need to limit your fluid intake before the procedure. Just before it, youll need to empty out your bladder.
The urinary catheter is inserted through the urethra . The solution containing the BCG is injected into the catheter. The catheter is clamped to help the BCG remain inside the bladder, where it can start to work. You may be asked to roll around a bit to help the medication reach all parts of the bladder. After a couple of hours or so, the catheter is unclamped. The fluid drains away, and someone removes the catheter.
Because BCG therapy includes an active, live bacteria, youll need to take certain precautions. For about six hours after the treatment, you should urinate while seated . During this time, you should also add bleach to the toilet for 15 minutes before flushing. This will help disinfect the toilet. You should also wash your genital region and your hands carefully. After the treatment, you should increase your fluids to better help flush out the bladder.
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Developing A Treatment Plan
In cancer care, different types of doctors often work together to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. This team is usually led by a urologist, a doctor who specializes in the genitourinary tract, or a urologic oncologist, a doctor who specializes in treating cancers of the genitourinary tract. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
Treatment options and recommendations depend on several factors, including:
The type, stage, and grade of bladder cancer
Possible side effects
The patients preferences and overall health
Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.
The first treatment a person is given for advanced urothelial cancer is called first-line therapy. If that treatment stops working, then a person receives second-line therapy. In some situations, third-line therapy may also be available.
Adjuvant systemic therapy is treatment that is given after radical surgery has been completed. In bladder cancer, adjuvant therapy is usually cisplatin-based chemotherapy or treatment in a clinical trial. Neoadjuvant therapy is treatment that is given before surgery, such as cisplatin-based chemotherapy.
Treatments by type and stage of bladder cancer: