Differences In Adverse Events Among Different Bcg Strains
Side effects seem similar for all BCG strains used , but frequency differs from one study to another. No differences between strains in side effects have been noted in a meta-analysis25 and in a recent study comparing Tice versus Connaught strain.26 The dose and treatment schedules used differ among studies, and therefore, comparison among them is difficult. Ideally, the dose should be expressed on colony-forming units as there are strong variations of factors 14 among the commercial preparations. Many studies do not mention this information and express the dose in milligrams.
Another problem is that the side effects of BCG have not been evaluated in a standard way in many studies, resulting in large differences in the frequency of local side effects of BCG. A classification of these side effects, taking into account severity and duration, has been proposed and validated,7 but this was not commonly applied by the urologic community.
Is Bcg Treatment Contagious To Others
Yes. The drugs used for BCG treatment contain live bacteria, which can be passed to other people. To reduce the risk of contamination, follow these instructions for six hours after every BCG treatment:
- Dont use public toilets.
- Drink lots of fluids to dilute your pee.
- Sit down on the toilet to avoid splashing.
- After you pee, add 2 cups of undiluted bleach to the toilet, close the lid, wait 15 to 20 minutes and then flush.
- If you have urinary incontinence , immediately wash your clothes in a washing machine. Dont wash them with other clothes.
- If you wear an incontinence pad, pour bleach on the pad, allow it to soak in, then place it in a plastic bag and discard it in the trash.
Typically, youll need to refrain from having sex for a few days after each BCG treatment session. In addition, use a condom any time you have sex throughout the entire course of treatment. Ask your healthcare provider about specific guidelines regarding sex.
Chemotherapy For Bladder Cancer
Chemotherapy uses anticancer drugs to destroy cancer cells. It is sometimes used to treat bladder cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.
Chemotherapy is given for different reasons. You may have chemotherapy to:
- destroy cancer cells in the body
- shrink a tumour before other treatments such as surgery or radiation therapy
- destroy cancer cells left behind after surgery and reduce the risk that the cancer will come back
- make cancer cells more sensitive to radiation therapy
- relieve pain or control the symptoms of advanced bladder cancer
Chemotherapy for bladder cancer that has not grown into the muscle of the bladder wall is given as intravesical therapy, which means that the drugs are placed directly into the bladder. Chemotherapy may also be a systemic therapy given through a needle into a vein. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the bladder.
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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.
I Felt Great After The First 4 Treatments
At best after each treatment of BCG I felt a bit wobbly and maybe even a bit tired. I could never be sure however if this was in my mind or a reality. When you have cancer and a professional tells you that you may feel tired after treatment, you feel tired even if you’re not. I basically felt great, but took the advice to rest and did nothing for that day. The following day I was up and about, going to the gym or riding my bike with no side effects. I even took to posting on social media, with photos of how great I was feeling and my family were amazed at how unaffected I was. This remarkable reaction to my treatment lasted another four visits and I was looking forward to the end of my cycle.
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This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care providerâs examination and assessment of a patientâs specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at .
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 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.
Bcg Treatment For Bladder Cancer
BCG is the standard treatment used for early-stage bladder cancer, and is used specifically on a cancer type known as high-risk non-muscle invasive bladder cancer .
For high-risk stage 0a bladder cancers, BCG is often given shortly after surgery. BCG is also used for stage 0is and stage 1 cancers, which have only spread into the lining of the bladder and not into deeper layers of tissue, muscle or to other parts of the body. BCG isnt typically appropriate for cancer cells that have spread outside the bladders lining.
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Prevention And Treatment Of Side Effects
The side effects of immune checkpoint inhibitors therapies are usually caused by the immune system attacking normal body parts in the same way it attacks cancer cells. Different types of immunotherapies can cause various side effects, many of which depend on the type of treatment, the tumor type and location, and the patients general health condition. Immunotherapy side effects can be mild, moderate, or even life-threatening. Some side effects can resolve on their own within a certain time frame while others persist and worsen. In such cases, it should be considered to taper the dosage, discontinue, or change the medication. Indeed, prevention of the occurrence or worsening of side effects is essential for effective treatment of these patients population. At the end of immunotherapy, it is important to observe side effects, some of which may occur months or years later . Side effects of immune checkpoint inhibitors therapies may affect the following parts of the body.
Table 2 List of serious complications and brief prevention methods for bladder cancer.
When You Go Home
Some hospitals allow you to go home with the medicine in your bladder if you live close by and are okay with the treatment. Your team will let you know if you can do this. You should follow the advice on what to do when you pass urine.
You need to drink lots of fluid after this treatment for 24 hours. It helps clear your system of the BCG.
You should not have sex for 24 hours after each treatment. During your course of treatment and for a week afterwards, you should wear a condom during sex.
Having bladder cancer and its treatment can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
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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
Lowering The Bcg Dose
Low-dose BCG has been tried in an attempt to decrease the frequency and severity of the side effects.34 In this study, one-third dose BCG was found as effective as a full dose in the prevention of recurrence and progression. However, patients with multifocal tumors fared better with the standard dose. In a later study, they confirmed similar efficacy of one-third dose versus full dose in high-grade and high-risk tumors,35 while overall side effects were significantly less. However, the number of patients who discontinued BCG for toxicity and the severe complications were similar in both arms. A third report of the same group found that one-sixth dose was significantly less effective than one-third dose,36 and therefore should not be used. The EORTC showed in a Phase II marker lesion study that a quarter dose was still effective.37 So, this is probably the lowest dose that can be advocated regarding efficacy.
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What Are The Side Effects
Some patients have difficulty completing long-term BCG therapy because of irritation in the bladder.2 To help with this irritation, the treatment frequency may be adjusted to give you a longer break between treatments. You may not notice any reaction after the first few BCG treatments. After the third treatment, patients usually start to experience bladder irritation pain or burning during urination, joint pain, fatigue, and flu-like symptoms that can last a few days. Most symptoms and side effects can be treated with over-the-counter pain medicines.
While BCG is a fairly common treatment for bladder cancer, every person has different experiences. It’s important to talk to your doctor about any questions or concerns you may have at any point during your treatment. Being mentally prepared for what to expect can help to reduce stress or uncertainty about treatment or help you think of additional questions for your healthcare team.
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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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 Bcg Treatment Contagious
Because BCG contains live bacteria, precautions are necessary to prevent it from being passed to others.
Patients should go to the bathroom sitting down to reduce splashing and wash their hands thoroughly after urinating. Pouring bleach into the toilet after use may also prevent contamination.
Once home, a patient should drink plenty of liquids and avoid sexual contact with others for 24 hours.
Research has shown that BCG may also reduce the risk of contracting a respiratory tract infection, giving your immune system a boost. However, precautions are still necessary to stay healthy.
The care team will talk to the patient about what to expect and provide instructions to follow at home.
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What To Expect Before Bcg Treatment
Before you are scheduled for BCG therapy, you will have to go through a screening test. This screening will determine whether you are eligible for BCG treatment or not. Factors considered during this screening test include the patients age, cancer type and stage, and overall health.
The doctor along with a radiation therapist will determine the best course of treatment for your condition and also ask you to avoid drinking too much fluid like water, juice, or caffeine.
If you are eligible, you will be given a date to schedule your treatment and will receive specific instructions on how to prepare. Once BCG is injected into the bladder, you will have to wait for 1-2 hours before urinating. This will allow the medicine to reach all the areas of the bladder.
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The success rate of bladder cancer treatment will vary depending on the age of the patient and the stage of the disease. Bladder cancer is a common and treatable disease, but bladder cancer treatment can be complex and challenging.
There are different treatment options available, each with different pros and cons. The best treatment option for you will depend on your situation and health.
We hope the information was helpful for you to understand what BCG treatment is, its symptoms, and what you can expect after the treatment. This method of treatment is considered a form of immunotherapy, which is an emerging form of cancer treatment.
Who Can Have This Treatment
BCG is appropriate for noninvasive and minimally invasive bladder cancers. It usually follows a procedure called transurethral resection of bladder tumor . Its intended to help prevent recurrence.
This treatment only affects cells inside the bladder. Its not useful for later stage bladder cancer that has spread into or beyond the bladder lining, or to other tissues and organs.
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Other Treatments For Bladder Cancer
For many early-stage bladder cancers, BCG is the best option for treatment. Other treatments for bladder cancer include:
- Surgery to remove the tumor: Early cancers can be removed with TURBT surgery. More advanced cancers may require more extensive surgery, like removal of part or all of the bladder .
- Intravesical chemotherapy: This treats the inside of the bladder with chemotherapy drugs. Chemotherapy drugs commonly used for bladder cancer include Mutamycin , Gemzar , or Valstar .
- Radiation therapy
- Clinical trials
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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