Monday, January 23, 2023

Complications Of Bcg Treatment For Bladder Cancer

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Lowering The Bcg Dose

When BCG for Bladder Cancer Goes Rogue and How It Impacts TB Clinicians

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.

Difficulties In Diagnosis Of The Severe Side Effects

If the side effects occur shortly after the instillation, the relationship with BCG can be made easily. Nevertheless, the side effects mostly occur when the patient is already back at home and generalists are not familiar with the complications of BCG. Therefore, it is highly advocated to inform the family doctor of the patient on the treatment and its possible complications, alarm symptoms, and practical attitude to solve the problem.

A second problem is that complications occur late, up to years after the treatment, when the urologist, who gives it, is no longer involved. Additionally, many of the complications give symptoms elsewhere in the body, and the patient goes to specialists who, again, are unfamiliar with BCG manifestations or even unaware of this treatment. Therefore, an information document should be delivered to each patient treated with the possible late complications. This is the way we handle it since many years. Although we have no proof, we are convinced that this can help to come to a more rapid diagnosis by colleagues of other specialties. This is important as the outcome of a complication is often dependent on early treatment initiation.

How To Take Bacillus Calmette

BCG is given directly into the bladder through a catheter. The medicine is left in the bladder for 1-2 hours. The dosage and schedule is determined by your healthcare provider. It is not uncommon to have urinary frequency or painful urination for 48 hours after treatment. If this continues after 48 hours, call your doctor or nurse.

How the Intravesicular Treatment is Given

  • You should limit your fluid intake starting the night prior to the procedure and have no fluids for 4 hours before. This is so you will be able to hold your urine in during the procedure for the full treatment time. In addition, the area receives more concentrated doses of the medicine with less urine output during the procedure.
  • If you take a diuretic , you will be told to not take this for at least 4 hours before the procedure.
  • A urinary catheter is inserted into the bladder and any urine is drained.
  • The BCG is given through the catheter, into the bladder. The catheter may be removed or clamped and remain in place based on your providers recommendation.
  • You will need to hold the BCG in your bladder for 1-2 hours. You may need to change positions every 15 minutes to be sure the medicine reaches all areas of the bladder. Do this by rolling on your side, back, other side, and stomach.

Precautions After Treatment

  • Wash your hands and genital area with soap and water after urinating to remove any traces of the medication from your skin and prevent skin irritation.
  • Recommended Reading: How Do They Remove A Tumor From The Bladder

    Avoid Factors Favoring Side Effects

    Several of the severe general side effects could be correlated with traumatic instillation or with instillations given early after the transurethral resection.27,28 Therefore, it is recommended not to start the instillations within the first 14 days after the resection or when there is still macroscopic hematuria, suggesting insufficient healing of the resection wound. BCG should not be given after a traumatic catheterization as there is an open wound that can give direct access to the blood circulation provoking disseminated BCG infection. Many experts suggest delaying treatment in the presence of bacterial cystitis because the barrier for the BCG to reach the bloodstream is traumatized. However severe side effects continue to appear even after respecting the aforementioned rules.

    When To See A Doctor

    BCG Treatment

    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

    Also Check: What Can Be Done About Bladder Leakage

    Who Can Use Bcg

    BCG is a treatment for early-stage bladder cancer that has not yet invaded the muscle of the bladder wall. Called non-muscle invasive bladder cancers or in situ bladder cancers, these account for about half of all bladder cancers.

    For 2021, it was estimated that about 83,730 new cases of bladder cancer would be diagnosed in the United States, and about 17,200 American bladder cancer patients would die from the disease.

    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.

    Read Also: How To Get Rid Of A Bladder Infection Without Antibiotics

    Possible Side Effects Of Bcg

    There are a number of things you can do to manage the side effects of BCG. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

    Bladder Irritability

    This medication can cause irritation to the bladder, including difficulty or painful urination , blood in the urine , and increased urgency , or frequency of urination. Patients are advised to increase fluid intake after administration of this medication to “flush” the bladder. You should report any of the urinary symptoms listed above that last more that 48 hours to your healthcare team for further management instructions.

    Fatigue

    Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

    Flu-like Symptoms

    Your doctor or nurse can recommend medication and other strategies to relieve aches, pains, and generalized malaise.

    BCG Infection Reaction

    Reproductive Concerns

    What Is Bcg Treatment

    Management of BCG Unresponsive Cystectomy Ineligible Bladder Cancer Patients Pembrolizumab

    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.

    Recommended Reading: What Causes Frequent Bladder Infections

    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

    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.

    Read Also: Small Cell Bladder Cancer Survival Rate

    Local Infections With Bcg

    BCG can invade the prostate and the seminal vesicles up to the epididymis. These diseases require a triple tuberculostatic treatment. Often fluoroquinolone is one arm of it. The duration varies from one study to another from 3 to 6 months. Orchiepididymectomy may be a rapid solution for a severely symptomatic patient, but it does not replace the general tuberculostatic treatment that should be continued.13 In rare cases, transurethral resection of the prostate is necessary to solve obstruction. Asymptomatic granulomatous prostatitis, however, was found to be frequent after intravesical BCG therapy but does not require treatment.14

    BCG balanitis or contact dermatitis has been described and can be handled with local steroids. Careful cleaning of hands and genital region after drug handling and voiding should prevent it.

    Granulomatous balanitis, however, can present with multiple erythematous and painless nodules of the glans, which should be treated with systemic triple tuberculostatic drug therapy.13,40

    How Bcg Is Used For The Treatment Of Bladder Cancer

    BCG Treatment

    Treatment for bladder cancer via BCG is accompanied by intravesical chemotherapy and radiation therapy. Patients receiving such treatments are then given BCG doses to help fight any remaining cancer. BCG helps prevent cancer from coming back after treatment of the bladder lining. It is given when there is a high possibility of relapse from treatment, particularly when cancer starts growing into the bladders muscle lining .

    BCG immunotherapy involves a combination of direct effects and an induced immune response. Upon insertion directly into the bladder , the dose of BCG triggers an immune response. Immune cells, named cytotoxic T lymphocytes, natural killer cells, neutrophils, and macrophages recognise and destroy the cancer cells, subsequently minimising the cancerous site.10

    During treatment, a catheter is used to insert the BCG into the bladder. Firstly, patients must ensure that they are lying down, are comfortable, and have a limited amount of fluid in the bladder. Once the BCG has been introduced, patients must lie on their front for 15 minutes. Those treated should not pass urine for 2 hours post-insertion to allow the BCG treatment to be fully effective. The effectiveness of BCG treatment is maximised when conducted on an empty bladder, which increases the concentration of BCG.

    Read Also: Foods To Help Bladder Infection

    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.

    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

    Read Also: Can You Get A Uti From Holding Your Bladder

    Prevention Strategies To Reduce The Side Effects Of Bcg Treatment

    Several strategies can alleviate the side effects of treatment:

    • NSAIDs: anti-inflammatory drugs such as ibuprofen, aspirin or diclofenac are all effective for minimising pain, inflammation and fever associated with BCG-therapy side effects.
    • Corticosteroids: steroids that suppress the immune system to decrease swelling and relieve inflammation.
    • Avoid factors that directly favour side effects: some side effects directly result from traumatic instillation of BCG or instillation after transurethral resection. Avoid treatment for no less than two weeks post-resection and post-urethral perforation.
    • Administration of TB drugs: a 2006 study found that administration of the antibiotic Ofloxacin reduced moderate-severe side effects by up to 18.5%.31

    Bcg Side Effects And Complications

    Bladder Cancer, BCG, and Covid-19 | Treatment Vaccine Update for Patients and Families

    I’d like some advice and info from anyone who can help. My father was diagnosed with Bladder Cancer in November. Lives in Holland so it’s difficult to get answers to my questions. First TURBT was in December all went okay, another 4 weeks later to check for scarring etc. Then the BCG Treatment started, 6 week course. The first 3 were fine and then he started getting really sick with the treatment. Vomitting, high fever, weakness, loss of appetite. He was given antibiotics but same thing happened on the 4th and 5th treatment. By the 6th treatment he was so sick he was not able to dress himself as his been so weak. He was taken to A& E and had a seizure in the waiting room, stayed one night was given more antibiotics and fluids and then sent home. They said they won’t be continuing with the BCG but won’t know the options until we get some results in a months time but his in such a bad way. Struggling to walk with joint pain, very down and depressed as he needs so much help and support with simple tasks. Is this normal after BCG? How long will he be feeling like this? Has anyone had a similar experience? What other treatments have you had and were they successful. Sorry for so many questions, I just don’t want him to suffer anymore.

    Recommended Reading: Why Can I Not Empty My Bladder

    Side Effects Not Requiring Immediate Medical Attention

    Some side effects of bcg may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

    Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

    More common

    • Burning during first urination after treatment

    After you stop using this medicine, it may still produce some side effects that need attention. During this period of time, Check with your doctor immediately if you notice the following side effects:

    • Cough

    Applies to bcg: intravesical powder for reconstitution, percutaneous powder for injection

    How Is Bcg Given

    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 tell you what safety measures to follow after you go 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.

    Also Check: Can Fibroids Cause Bladder Leakage

    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.

    What To Expect During Bcg Treatment

    Complications of Intravesical BCG Immunotherapy for Bladder Cancer ...

    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.

    Read Also: Portable Bladder Scanner For Home Use

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