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.
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.
What Is The Success Rate Of Bcg Treatment For Bladder Cancer
Bladder cancer is a relatively common cancer that affects the urinary system. If not treated early, it can spread to other parts of the body and become fatal.
Bladder cancer is most commonly diagnosed in older adults. It grows slowly and usually does not cause symptoms until it is large and spreads to other organs.
Bladder cancer treatment options include chemotherapy and radiation therapy. Patients who are diagnosed with this kind of cancer are usually given BCG treatment to help fight cancer. Lets have a look at the success rate of BCG treatment for bladder cancer.
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Treating Stage Iv Bladder Cancer
These cancers have reached the pelvic or abdominal wall , may have spread to nearby lymph nodes , and/or have spread to distant parts of the body . Stage IV cancers are very hard to get rid of completely.
Chemotherapy is usually the first treatment if the cancer has not spread to distant parts of the body . The tumor is then rechecked. If it appears to be gone, chemo with or without radiation or cystectomy are options. If there are still signs of cancer in the bladder, chemo with or without radiation, changing to another kind of chemo, trying an immunotherapy drug, or cystectomy may be recommended.
Chemo is typically the first treatment when bladder cancer has spread to distant parts of the body . After this treatment the cancer is rechecked. If it looks like it’s gone, a boost of radiation to the bladder may be given or cystectomy might be done. If there are still signs of cancer, options might include chemo, radiation, both at the same time, or immunotherapy.
In most cases surgery cant remove all of the cancer, so treatment is usually aimed at slowing the cancers growth and spread to help people live longer and feel better. If surgery is a treatment option, it’s important to understand the goal of the operation whether it’s to try to cure the cancer, to help a person live longer, or to help prevent or relieve symptoms from the cancer.
Because treatment is unlikely to cure these cancers, many experts recommend taking part in a clinical trial.
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.
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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.
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.
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Clinical Outcomes Of The Gemdoce Combination Were Promising Approaching 50 Percent Recurrence
A better approach? Kates and colleagues have begun investigating a combination of two chemotherapy drugs, gemcitabine and docetaxel , delivered directly in the bladder in the same way that BCG is instilled for newly diagnosed bladder cancer patients. In previously published work at the Brady, as part of a multi-institutional study, Kates and Trinity Bivalacqua, M.D., Ph.D., evaluated patients who were given GEMDOCE when bladder tumors recurred after BCG. Clinical outcomes of the GEMDOCE combination were promising, says Kates, approaching 50 percent recurrence-free survival at two years when used with monthly maintenance. Based on these promising results, Kates has opened a Phase 2 clinical trial to evaluate this combination for newly diagnosed patients who have not had previous BCG. We will also be looking for a biomarker that can predict response to GEMDOCE, which would help us guide newly diagnosed patients either to intravesical chemotherapy or BCG immunotherapy, based on their tumor biology. More information on this clinical trial can be found here.
Even more exciting: We identified unique immune gene expression signatures found only in patients with CIS, says Hahn. Next, the team plans to investigate whether these new CIS signatures are associated with response to BCG and other forms of bladder cancer immune therapy.
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.
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Immunotherapy And New Conservative Treatment Avenues Following Bcg Failure
We previously demonstrated that many elements of BCG were immunologically active and that there is interest in using its mycobacterial subcomponents rather than the living BCG.44 Morales and colleagues, well-known for being the first to report on intravesical BCG use in 1976, assessed the clinical efficacy and safety of another immunomodulator, mycobacterial cell wallDNA complex following intravesical administration in patients with CIS.45 Mycobacterial cell wallDNA complex is a cell wall DNA compound prepared from a culture of the bacterium Mycobacterium phlei. Fifty-five patients received 4 mg or 8 mg MCC emulsion. Patients were previously treated with BCG except for 8 who were treatment-naïve and 2 who received chemotherapy. The CR rate was 27.3% at weeks 12, and 26% in the 4 mg group, while 46.4% of patients receiving 8 mg had a CR at both time points. Urocidin, a formulation of MCC commercialized by the Canadian company Bioniche, is currently being tested in a Phase III clinical trial in patients with NMIBC with BCG failure and has included the University Health Network/University of Toronto in the trial. It completed recruitment for the initial Phase III registration trial in March 2009.
From Bcg To Chemo Combos
Non-muscle-invasive bladder cancer is so called because the tumor resides strictly in the bladders interior lining, called the mucosa. Among other tasks, this mucosal lining operates as a barrier between the smooth muscle that encases the bladder and the urine within it.
About 70%75% of bladder cancer diagnoses are NMIBC and about 25% of these are at high risk of progressing to muscle-invasive bladder cancer.
A tumor is called high-risk when its size or other features suggest that its biologically aggressive. One form of high-risk NMIBC, for example, is called carcinoma in situ, in which the tumor spreads along the mucosa in a pancake-like shape. These tumors are not only aggressive, Dr. Packiam explained, but particularly resistant to treatment with BCG. And when they do come back, its often in a more invasive form.
The treatment course for high-risk NMIBC begins with removing the bladder tumors via a surgical procedure called TURBT. Surgery is followed by additional treatments, known as adjuvant therapy, to kill off any remaining cancer cells and reduce the risk of the cancer coming back.
For decades, adjuvant therapy with BCGa severely weakened form of a bacterium that was originally developed as a tuberculosis vaccinewas the gold standard for preventing progression and recurrence in high-risk NMIBC, he explained.
Is Using Less Bcg Okay
Researchers are investigating another potential solution to the BCG shortage: using a lower dose of BCG per treatment. Several studies have suggested that using a lower dose may be a suitable option, including a study published last year showing that, in people with high-risk NMIBC, using one-third of the standard dose of BCG didnt appear to be any less effective than the standard full dose.
The study had a large population of people with high-risk tumors that are often resistant to BCG and they are still getting very good numbers, he said.
Nevertheless, evaluating how the combination performs in people from different racial and ethnic backgrounds will be important.
Weve seen time and again that something can perform well in , but once it gets to the community, we can see differing results, Dr. Gurram said.
The need to travel to the hospital monthly to get the maintenance treatment is a challenge of this particular regimen, Dr. Packiam noted. Thats particularly true in rural areas and for people without easy access to transportation.
It does produce some logistical burdens for patients, he said.
Along those lines, Dr. Meeks and his colleagues wondered about the extent to which maintenance therapy is even needed. As with BCG treatment, over time, many patients stop taking it. So it will be important to determine if 6, 12 or 24 months of is necessary, they wrote.
But, honestly, revisiting old chemotherapies that give promising results is great to see.
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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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.
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.
How Is Bcg Given
BCG is injected directly into the bladder using a catheter inserted into the urethra . You will receive this medicine in a clinic or hospital setting.
BCG is usually given once every week for 6 weeks, and then given every 3 to 6 months for up to 2 years. Follow your doctor’s instructions about your specific dosing schedule.
You will need to hold the medicine in your bladder as long as possible up to 2 hours. During that time you will be encouraged to reposition from your left side to right side and also you should lie upon the back and the abdomen, changing these positions every 15 minutes to maximize bladder surface exposure to the agent.
For at least 6 hours after you are treated with BCG, your urine will still contain some of the medication and the bacteria it is made from. To prevent the spread of this bacteria, use a toilet rather than a urinal, and sit on the toilet while urinating.
Before you flush the toilet, disinfect the urine with household bleach in an amount that is approximately equal to how much you have urinated. Pour the bleach into the toilet in which you urinated, let it stand for 15 minutes and then flush.
Your doctor may ask you to drink extra fluids for several hours after your BCG treatment to help flush out your bladder. Follow all instructions.
This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using BCG.
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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.
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.
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