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Bcg Tx For Bladder Cancer

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Family History Of Bladder Cancer

Case 1: Non-Muscle Invasive, BCG-Refractory Bladder Cancer

You may be twice as likely to develop bladder cancer if you have a close relative who has had the disease. A close relative includes a parent, sibling, or child. This possibility may be related to genetic factors that make it harder for the body to remove dangerous chemicals after exposure. In addition, an inherited disease linked to colorectal cancer called Lynch syndrome also increases the risk of bladder cancer.

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.

How Does Immunotherapy Work Against Cancer

As part of its normal function, the immune system detects and destroys abnormal cells and most likely prevents or curbs the growth of many cancers. For instance, immune cells are sometimes found in and around tumors. These cells, called tumor-infiltrating lymphocytes or TILs, are a sign that the immune system is responding to the tumor. People whose tumors contain TILs often do better than people whose tumors dont contain them.

Even though the immune system can prevent or slow cancer growth, cancer cells have ways to avoid destruction by the immune system. For example, cancer cells may:

  • Have genetic changes that make them less visible to the immune system.
  • Have proteins on their surface that turn off immune cells.
  • Change the normal cells around the tumor so they interfere with how the immune system responds to the cancer cells.

Immunotherapy helps the immune system to better act against cancer.

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In Vitro Evidence Of Human Immune Responsiveness Shows The Improved Potential Of A Recombinant Bcg Strain For Bladder Cancer Treatment

  • 1Laboratório de Desenvolvimento de Vacinas, Instituto Butantan, São Paulo, Brazil
  • 2Programa de Pós-Graduação Interunidades em Biotecnologia USP-I.Butantan-IPT, São Paulo, Brazil
  • 3Laboratório de Imunologia Aplicada, Departamento de Genética e Evolução, Universidade Federal de São Carlos, São Carlos, Brazil
  • 4Institute of Genetic and Biomedical Research, National Research Council, Cagliari, Italy
  • 5Institute of Protein Biochemistry, National Research Council, Naples, Italy

After Bladder Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Bladder Or To Other Parts Of The Body

IBCN 2020: Tumor Immune Microenvironment in Response to ...

The process used to find out if cancer has spread within thebladder lining and muscle or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

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Immunotherapy Of Urinary Bladder Carcinoma: Bcg And Beyond

Submitted: April 12th 2012Reviewed: November 27th 2012Published: May 9th 2013

DOI: 10.5772/55283

  • University of Iowa, Department of Urology Iowa City, Iowa, USA
  • Eric J. Askeland

  • University of Iowa, Department of Urology Iowa City, Iowa, USA
  • University of Iowa, Department of Urology Iowa City, Iowa, USA
  • Jonathan R. Henning

  • University of Iowa, Department of Urology Iowa City, Iowa, USA
  • Michael A. ODonnell

  • University of Iowa, Department of Urology Iowa City, Iowa, USA
  • *Address all correspondence to:

    What Do I Need To Know To Prepare For Bcg Treatment

    • Restrict your fluid intake, caffeinated beverages and use of diuretics 4 hours prior to procedure if possible.
    • Do not void for 1 to 2 hours after the procedure, if possible.

      After your first urination following the procedure and for six hours afterward, you will be asked to follow these instructions:

    • Sit to void to avoid urine splashing. Do not use public toilets or void outside.

    • After each void add 2 cups undiluted bleach to toilet, close the lid and wait 15-20 minutes and then flush the toilet. Repeat with each void for 6 hours.
    • Increase fluid intake to dilute the urine. Begin after the first void post procedure.
    • If you are sexually active, wear a condom with intercourse throughout the entire treatment course.
    • If you have urinary incontinence, immediately wash clothes in clothes washer. Do not wash with other clothes.
    • If wearing incontinence pad, pour bleach on pad, allow to soak in, then place in plastic bag and discard in trash.
    • Acetaminophen or ibuprofen may be used for fever and body aches.
    • You may need antispasmodic medication to help with frequency and urgency.

    Also Check: How To Take Care Of A Bladder Infection At Home

    When To See A Doctor

    There are a few side effects that can be especially dangerous, so make sure to talk to your doctor if you notice that you:

    • Have a severe skin rash
    • Are wheezing or having difficulty breathing
    • Are finding swallowing to be difficult
    • Have a high fever that isnt lowered with Tylenol or other over-the-counter fever reducers

    How You Have It

    BCG Failure: Defining Failure and Managing Difficult Cases of Non-Muscle Invasive Bladder Cancer

    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.

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    When You Have It

    You usually have BCG into the bladder once a week for 6 weeks. This is called the induction course.

    You may then have BCG into the bladder every few weeks or months for the next 1 to 3 years. This will depend on your risk of developing invasive bladder cancer. This is called maintenance BCG therapy.

    You usually have treatment at the cancer day clinic.

    Bcg In Perspective: Advances In The Treatment Ofsuperficial Bladder Cancer

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    Availability Of Data And Materials

    The datasets supporting the conclusions of this article are available in the National Health Insurance Research Database, Taiwan .

    Only citizens of the Republic of China who fulfill the requirements of conducting research projects are eligible to apply for the National Health Insurance Research Database . The use of NHIRD is limited to research purposes only. Applicants must follow the Computer-Processed Personal Data Protection Law and related regulations of National Health Insurance Administration and NHRI , and an agreement must be signed by the applicant and his/her supervisor upon application submission. All applications are reviewed for approval of data release.

    How Is Bcg Given

    BCANTT 2020: BCG Unresponsive High

    The combination of BCG and TURBT is the most effective treatment for high-risk non-muscle-invasive bladder cancer. BCG is given once a week for six weeks, starting 24 weeks after TURBT surgery. It is put directly into the bladder through a catheter. You may be asked to change position every 15 minutes so the vaccine washes over the entire bladder. This is usually done as a day procedure in hospital, and each treatment session takes up to two hours.

    Your treatment team will outline some safety measures to follow afterwards at home. This is because BCG is a vaccine that contains live bacteria, which can harm healthy people.

    Let your doctor know of any other medicines or complementary therapies you are using, as they may interfere with how well the bladder cancer responds to BCG. For example, the drug warfarin is known to interact with BCG.

    Read Also: How Many Radiation Treatments For Bladder Cancer

    There Are Three Ways That Cancer Spreads In The Body

    Cancer can spread through tissue, the lymph system, and the blood:

    • Tissue. The cancer spreads from where it began by growing into nearby areas.
    • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
    • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

    Treatment Of Recurrent Bladder Cancer

    For information about the treatments listed below, see the Treatment Option Overview section.

    Treatment of recurrentbladder cancer depends on previous treatmentand where the cancer has recurred. Treatment for recurrent bladder cancer mayinclude the following:

    Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

    Also Check: Why Does My Bladder Feel Full After I Pee

    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.

    International Bladder Cancer Group Consensus Statement On Clinical Trial Design For Patients With Bacillus Calmette

    Management of BCG Failure in Non-Muscle Invasive Bladder Cancer – Medpage Today
    • Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, CanadaDepartment of Urology, Toulouse Cancer Institute and Toulouse University Hospital, Toulouse, France
    • Seth P. LernerAffiliations
    • Departments of Urology, University of Lübeck, Lübeck, GermanyHELIOS Agnes-Karll-Krankenhaus, Bad Schwartau, Germany
    • Peter C. BlackCorrespondenceCorresponding author at: Department of Urologic Sciences, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.

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    Treating Bladder Cancer That Progresses Or Recurs

    If cancer continues to grow during treatment or comes back after treatment , treatment options will depend on where and how much the cancer has spread, what treatments have already been used, and the patient’s overall health and desire for more treatment. Its important to understand the goal of any further treatment if its to try to cure the cancer, to slow its growth, or to help relieve symptoms as well as the likely benefits and risks.

    For instance, non-invasive bladder cancer often comes back in the bladder. The new cancer may be found either in the same place as the original cancer or in other parts of the bladder. These tumors are often treated the same way as the first tumor. But if the cancer keeps coming back, a cystectomy may be needed. For some non-invasive tumors that keep growing even with BCG treatment, and where a cystectomy is not an option, immunotherapy with pembrolizumab might be recommended.

    Cancers that recur in distant parts of the body can be harder to remove with surgery, so other treatments, such as chemotherapy, immunotherapy, targeted therapy, or radiation therapy, might be needed. For more on dealing with a recurrence, see Understanding Recurrence.

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    How The Bacteria Found In A Tuberculosis Vaccine Can Improve The Outcome Of Bladder Cancer Treatment

    Ruth Williams

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    WIKIMEDIA COMMONS,

    Bacillus Calmette-Guérin is a puny cousin of the bacteria that causes tuberculosis, and as such serves as an excellent vaccine against the disease. But BCG is also used to treat bladder cancer. Research published today in Science Translational Medicine reveals how BCG achieves its cancer-fighting performance, and suggests the bug has a better chance of winning if the patient has a prior BCG vaccination.

    Since the 1970s, BCG has been used to help prevent bladder cancer from returning after surgical removal. Doctors have simply pumped the bladder full of the bacteria to induce a localized immune response that helps kill cancer cells.

    BCG has always fascinated everybody because here we have what seems like a barbaric approach to treating cancer, said Michael ODonnell, a urologist at the University of Iowa who did not participate in the study. And yet its more effective than any…

    Despite the effectiveness of the treatmentit successfully prevents recurrence in some 5070 percent of patientsno one had much of an idea how it worked. Its a piece of the puzzle thats been lacking for a long time, said ODonnell, until now.

    The new results suggest that we have to do this before the intravesicle administration, said Herr, and that makes immunologic sense.

    Optimal Bcg Treatment Of Superficial Bladder Cancer As Defined By American Trials

    IBCN 2019: Advanced Pathologic T1 Substaging to Improve ...

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    Treating Stage Ii Bladder Cancer

    These cancers have invaded the muscle layer of the bladder wall , but no farther. Transurethral resection is typically 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.

    When the cancer has invaded the muscle, radical cystectomy is the standard treatment. Lymph nodes near the bladder are often removed as well. If cancer is in only one part of the bladder, a partial cystectomy may be done instead. But this is possible in only a small number of patients.

    Radical cystectomy may be the only treatment for people who are not well enough to get chemo. But most doctors prefer to give chemo before surgery because it’s been shown to help patients live longer than surgery alone. When chemo is given first, surgery is delayed. This is not a problem if the chemo shrinks the bladder cancer, but it might be harmful if the tumor continues to grow during chemo.

    If cancer is found in nearby lymph nodes, radiation may be needed after surgery. Another option is chemo, but only if it wasn’t given before surgery.

    For people who have had surgery, but the features of the tumor show it is at high risk of coming back, the immunotherapy drug, nivolumab, might be offered. When given after surgery, nivolumab is given for up to one year.

    For patients who cant have surgery because of other serious health problems, TURBT, radiation, chemotherapy, or some combination of these may be options.

    Which Cancers Are Treated With Immunotherapy

    Immunotherapy drugs have been approved to treat many types of cancer. However, immunotherapy is not yet as widely used as surgery, chemotherapy, or radiation therapy. To learn about whether immunotherapy may be used to treat your cancer, see the PDQ® adult cancer treatment summaries and childhood cancer treatment summaries.

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    What Are The Types Of Immunotherapy

    Several types of immunotherapy are used to treat cancer. These include:

    • Immune checkpoint inhibitors, which are drugs that block immune checkpoints. These checkpoints are a normal part of the immune system and keep immune responses from being too strong. By blocking them, these drugs allow immune cells to respond more strongly to cancer.
    • Learn more about immune system modulators.

    Supply Still Limited In Us

    BCG dosing for bladder cancer: Standard frequency schedule correct

    Approached by Medscape Medical News for comment, Alexander Kutikov, MD, chief of urologic oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, confirmed that for many centers in the United States, the supply of BCG is still limited.

    At his own center, which is a high-volume facility, “the supply is being delivered to us preferentially, so we’ve been able to keep our heads above water and continue to treat our own patients as well as referrals from other practices that are out of BCG right now,” he noted.

    However, the supply of BCG is not infinite anywhere in the United States, “so we’re doing dose reduction routinely as well,” he added.

    The main difference Kutikov sees between Brazil and the United States regarding recommendations for use of BCG during periods of shortage is what he describes as the “luxury” that countries such as Brazil have in being able to import strains of BCG other than the ones produced in their own country.

    “The US is locked out of everything but the Tice strain, so Tice is the only FDA-approved strain in the US, but in Brazil, this is one of the ways they are suggesting to try and augment their own supply,” Kutikov explained.

    Kutikov also felt that it was interesting that Brazilian researchers appear to be advocating use of intravesical gemcitabine as a good alternative to BCG.

    “Usually, BCG has been tested against mitomycin,” he explained.

    “In this space, gemcitabine appears to have similar efficacy to mitomycin,” Kutikov noted.

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