Treating Stage Iii Bladder Cancer
These cancers have reached the outside of the bladder and might have grown into nearby tissues or organs and/or lymph nodes . They have not spread to distant parts of the body.
Transurethral resection is often done first to find out how far the cancer has grown into the bladder wall. Chemotherapy followed by radical cystectomy is then the standard treatment.Partial cystectomy is rarely an option for stage III cancers.
Chemotherapy before surgery can shrink the tumor, which may make surgery easier. Chemo can also kill any cancer cells that could already have spread to other areas of the body and help people live longer. It can be especially useful for T4 tumors, which have spread outside the bladder. When chemo is given first, surgery to remove the bladder is delayed. The delay is not a problem if the chemo shrinks the cancer, but it can be harmful if it continues to grow during chemo. Sometimes the chemo shrinks the tumor enough that intravesical therapy or chemo with radiation is possible instead of surgery.
Some patients get chemo after surgery to kill any cancer cells left after surgery that are too small to see. Chemo given after cystectomy may help patients stay cancer-free longer, but so far its not clear if it helps them live longer. 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.
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.
What Happens During Bcg Cancer Treatment
Before beginning BCG treatment, local anesthesia is given to numb the area and keep you comfortable. Next, your healthcare provider will place a catheter into your urethra and inject the liquid BCG solution into your bladder.
The BCG solution needs to come in contact with cancer cells to kill them. So, once the medication is injected, your healthcare provider will remove the catheter and ask you to lie on your back, stomach and both sides for 15 minutes each.
When the process is complete, youre free to leave your appointment. However, you should avoid peeing for at least one more hour.
How long do you hold BCG in your bladder?
Once the BCG solution is injected into your bladder, youll hold it for a total of two hours. After this point, youll be able to pee.
What does BCG do to the bladder?
When the BCG solution enters your bladder, your immune system cells begin to attack the cancer cells in your bladder.
BCG treatment schedule
The initial BCG cancer treatment occurs weekly for six weeks. This is called induction therapy.
If the treatment is working, your doctor may prescribe BCG maintenance therapy. Maintenance therapy is given once a week for three weeks at the three-, six- and 12-month marks. For some people, this may be continued up to three years.
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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.
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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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
Before Taking This Medicine
You should not receive BCG intravesical if you are allergic to BCG, or if you have:
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tuberculosis
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a weak immune system from diseases such as AIDS, leukemia, or lymphoma
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a fever, a bladder infection, or blood in your urine
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if you are using steroids or receiving chemotherapy or radiation treatments or
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if you have had a bladder biopsy, surgery, or catheter within the past 14 days.
Tell your doctor if you have any type of bacterial, fungal, or viral infection .
It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.
You should not breastfeed while being treated with BCG.
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Increased Diversity Of Tcr Repertoire After Bacillus Calmetteguerin Treatment
Antigens released from tumor cell killing upon BCG treatment could expand and recruit effector and memory T cells leading to an overall increase in the diversity of TCR in the tissue microenvironment. TCR clonal proportion and clonal space homeostasis at pre and 3M post-BCG were then analyzed to further decipher the impact of BCG treatment on the diversity of TCR in the tumor microenvironment.
Figure 4 Enhanced TCR repertoire diversity after Bacillus Calmette-Guerin treatment. Clonal proportion of the top n clonotypes. Red bar represents the clonal proportion taken by the 10 most abundant clones. Clonal proportion taken by top 10 most abundant clone at Pre and 3M post-BCG time point . 1 on Y-axis represents 100% of the total TCR repertoire. Proportion of homeostasis space occupied by clonotypes classified as rare , small , medium , large , and hyperexpanded 1 on Y-axis represents the 100% of the total TCR repertoire. Proportion of occupied homeostatic space for pre versus 3M post-BCG time points as classified by rare, small, medium, large, and hyperexpanded clone size, respectively. Graphs show mean with standard deviation. *p< 0.05 by Mann-Whitney U test. Connecting lines showed two pairs of matched pre- and post-BCG samples.
Taken together, the above data showed significant increase in smaller TCR clones suggesting the expansion of newly induced and potentially tumor-reactive T cells post-BCG.
Sex After Bcg Treatment
Men should use a condom during sex for the first week after each BCG treatment. If you are a woman having the treatment, your partner should use a condom during this time. This protects your partner from any BCG that may be present in semen or vaginal fluid. Your doctor or specialist nurse can give you more information about this.
Doctors do not yet know how BCG may affect an unborn baby. They will recommend you do not become pregnant or make someone pregnant while having it. You should use effective contraception during treatment. Your doctor or specialist nurse can give you more information about this.
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Aftereffects Of Bcg Bladder Treatment
Just trying to see if anyone else has had the same experience. Recently finished my second ‘maintenance’ treatment after being passed ‘clear’ following the main 6 treatments. So really good news but the aftereffects seem to be lasting much longer than previously. The bladder irritation after treatment usually went after two or three days but with this last treatment l still have a constant ache in the bladder/scrotum area three weeks after treatment? Pain is controlled by Paracetamol so not that severe but would like to hear from other sufferers to see if this eventually goes away?
Welcome to Cancer Chat Dave.
It’s great to read that you’ve finished the second maintenance treatment after being passed clear following the main 6 treatments although I’m sorry the after-effects you’re experiencing are lasting longer than usual.
I know you said the paracetemol is controlling the pain but do let your medical team or GP know about this as they may be able to help. I’ve had a quick look around the forum and thought you may like to connect with as she’s having some difficulty managing the pain from her BCG treatment at the moment and you may be able to help each other.
You can chat with our cancer nurses about your situation as well if you like. They’re available Monday – Friday between 9a.m – 5p.m on 0808 800 4040.
I hope this helps and that the after-effects disappear soon Dave.
All the best,
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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Bcg And Safety At Home
- For the first six hours after BCG treatment, sit down on the toilet when urinating to avoid splashing. Pour 2 cups of household bleach into the toilet bowl. Wait 15 minutes before flushing and wipe the toilet seat with bleach.
- If you are wearing incontinence pads, take care when disposing of them. Pour bleach on the used pad, allow it to soak in, then place the pad in a plastic bag. Seal the bag and put it in your rubbish bin. You may be able to take it back to the hospital or treatment centre for disposal in a biohazard bin.
- If any clothing is splashed with urine, wash separately in bleach and warm water.
- For a few days after treatment, wash your hands extra well after going to the toilet, and wash or shower if your skin comes in contact with urine.
- Speak to your doctor or nurse if you have any questions.
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.
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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.
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
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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.
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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Special Precautions At Home
Allthe urine you pass during the first 6 hours after treatment should be treatedas contaminated. After you have passed urine, it is recommended that you pour 2cups of household bleach into the toilet and leave this for 15 minutes beforeflushing. Ensure no one uses the toiletduring the 15 minutes or before flushing. Bleach neutralises the live BCG TB vaccine andyou should continue to do this for 6 hours after treatment.
Washhands/genital area with soap and water each time after passing urine for 6hours after your treatment.
Subjects And Blood Collection
Thirty-nine healthy adults were recruited at the Hospital Universitário, Universidade de São Paulo. Clinical history and blood counts and serological parameters were used to confirm the health conditions of the participants. Thirty-four participants reported vaccination with live BCG at birth, while five were not vaccinated. Ten milliliters of blood were collected into heparinized tubes. The study protocol was approved by the Comitê de Ética/Pesquisa Hospital Universitário/USP 728.275.
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Moving From The Lab To The Clinic
Dr. Glickmans laboratory is now collaborating with urologic surgeon Bernard H. Bochner to explore the clinical implications of this discovery particularly, whether analyzing a patients bladder cancer cells can reliably predict his or her responsiveness to BCG therapy.
With the support of a grant from The Society of MSKCC, Dr. Redelman-Sidi is trying to develop a lab test that would analyze urine samples, which usually contain cancer cells shed from the bladder. These cells could be tested both for their tendency to take up BCG and also for the presence of BCG-activating, cancer-causing mutations.
This would allow us to screen early-stage patients routinely before starting BCG therapy to make sure its the best course of treatment, Dr. Glickman says.
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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