Friday, April 19, 2024

How Does Bcg Work For Bladder Cancer

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Bcg Or Bladder Removal

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

Hi siderman. I was diagnosed with the most aggressive cancer in my bladder. I have had bcg treatment. As others have posted. I went to hospital once a week for 6 weeks initially . Then it dropped to once every 3 months and then once every 6 months. I cant lie i found the treatment a bit uncomfortable. It stings to pee for a few hours after treatment. You cant drink caffeine drinks for 24 hours so i had hot blackcurrant or orange. Drinking a mug of this each hour helped with stinging. Your back to normal reasonably quickly. I had headaches and felt bit achy for 24 hours afterwards. Its 2 years now since my diagnosis and the treatment has worked so well my consultant has stopped treatment this August. I now go back in february for a camera. Hoping i will be given the all clear.

Its a lot to take in and it is a shock. Only you can decide which is best for you. Me personally wanted to keep my bladder. I do run to the toilet more than i did but it does get better with time.

I had a really good network of people family and friends when i needed them. I did cry in private though as i felt i needed to be strong for those i cared about. Thats why this chat is brilliant. We all know what its like and can help each other with our own experiences. I wish you well whatever you decide to do.

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.

Physical Emotional And Social Effects Of Cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after an advanced cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, report that they are more satisfied with treatment, and they may live longer.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

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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.

When Do Doctors Use Bcg

BCG treatment for bladder cancer: What to know

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.

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If Treatment Does Not Work

Full recovery from bladder cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or metastatic.

This diagnosis is stressful, and for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, expertise, and knowledge to support patients and their families, and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is a specific type of palliative care designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

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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Treating Complications Of Bcg Therapy

If you do experience a problem from BCG infection, you may need to receive targeted antibiotics, such as isoniazid and rifampin.

Complications of BCG therapy sometimes dont occur until years later. That can happen if the BCG bacteria that spread in the body become reactivated. These complications can sometimes be tricky to diagnose. Medical imaging might first make your clinician concerned about cancer or about another type of bacterial infection.

Make sure that all your medical care providers know that you have had BCG therapy. That will help guide their diagnostic process and ensure you get the best possible care. In some cases, your clinician will want a tissue sample from the involved area to make sure that the problem is from a BCG infection and not from some other source.

When You Have It

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

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.

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Different Strains Of Bcg

There are several different strains of BCG available. The more commonly used strains include the Tice strain produced by Organon Teknika, the RIVM strain produced by Bilthoven, and the Connaught strain produced by Connaught Laboratories. Morales used a strain of BCG which came from the Institut Armand Frappier in Montreal, in fact BCG-Connaught is derived from this strain.

As there are several commercially available strains of BCG, uncertainty exists in the literature about whether the various strains of BCG have identical immunotherapeutic efficacy and identical clinical effectiveness. Given this fact direct comparison between clinical studies is difficult when different strains of BCG have been used.

Current Alternatives To Bcg

Research on improving NMIBC therapy has mainly focused on rescue patients who do not respond to BCG therapy, since BCG is truly efficacious in the majority of patients for avoiding recurrence and progression episodes. The alternative treatment options include virus and other bacteria different from BCG as vehicles for specific tumor growth inhibition agents or immunostimulatory components, chemotherapeutic agents, new delivery options for current therapies, and systemic immunotherapies that have to be demonstrated to be efficacious in other types of cancers .

Current alternative research for nonmuscle invasive bladder cancer treatment.

Virus-Based Treatments

Bacteria-Based Treatments

Chemotherapeutic Treatments and Improved Delivery

Different strategies can improve the use of chemotherapy for treating NMIBC. The appearance of new agents, the combination of different chemotherapeutic agents, the use of hyperthermia for improving intravesical instillation, or other strategies have been considered for improving the treatment of intermediate- and high-risk NMIBC patients.

The efficacy of intravesical therapies can also be improved through delivery adaptations such as hyperthermia, electromotive drug administration or new devices.

Checkpoint Inhibitors in Nonmuscle-Invasive BC

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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.

How To Define Treatment Failure After Bcg Treatment For Nonmuscle

BCG Treatment for Bladder Cancer Illustration by ATLAS Studios ...

Biographies:Related Content:Read the Full Video Transcript

Ashish Kamat: Welcome to UroToday’s Bladder Cancer Center of Excellence. I’m Ashish Kamat from MD Anderson Cancer Center. It’s again, a pleasure to welcome Peter Black from Vancouver, whom everybody knows really well. Peter is joining us today to share with us his thoughts on BCG-unresponsive bladder cancer from a slightly different perspective this time around. He’s going to summarize the thoughts he shared with us at the Virtual Think Tank this year, which was held earlier last month. Peter, the stage is yours.

This year’s meeting was planned for Denver. It was going to be a two-day meeting and Matt Galsky and Sima Porten were the chairs. But of course, because of COVID, it was reduced to a two-and-a-half-hour virtual meeting on August 7th. Colin Dinney and I were lucky to be the chairs of this part of it under the leadership of Matt and Sima. You can see here we had two panels. We had a clinical panel, as well as a translational panel. You can see some recognizable names on the list here. I would highlight that we had Karen Sachse, who is a representative of BCAN, so a patient advocate, and we were happy to have that input into some of the topics of discussion.

Peter Black: Its long-term optimism.

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Are There Any Side Effects

Most procedures have possible side-effects. Although the complications listed below are well-recognised, most patients do not suffer any problems.


  • Urinary tract infection .
  • Some bladder discomfort.
  • Flu-like symptoms which can last for 2 3 days.
  • Urgently needing to pass urine, and wanting to pass urine more frequently, which can last for 2 3 days.


  • Narrowing of the urethra following repeated use of a catheter.
  • Inflammation which can affect various parts of the body .


  • Persistent or severe pain after treatment, sometimes leading to removal of the bladder.
  • Generalised and possibly serious infection with the BCG bacteria needing treatment in hospital with powerful antibiotics.

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

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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.

What Happens During Treatment

Management of BCG Unresponsive Cystectomy Ineligible Bladder Cancer Patients Pembrolizumab

A urinary catheter is inserted through your urethra and into your bladder. Then the BCG solution is injected into the catheter. The catheter is clamped off so the solution stays in your bladder. Some doctors may remove the catheter at this time.

You have to hold the medicine in your bladder. Youll be instructed to lie on your back and to roll from side to side to make sure the solution reaches your entire bladder.

After about two hours, the catheter is unclamped so the fluid can be drained. If the catheter was already removed, youll be asked to empty your bladder at this time.

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Box : Prognostic Factors For Recurrence

  • Number of tumours more tumours mean more frequent recurrences.

  • Previous recurrence rate* or a recurrence at three months.

  • Size of the tumour those > 3 cm carry a worse prognosis.

  • Grade of anaplasia.

  • Presence of CIS.

*The recurrence rate being the number of positive cystoscopies per year over the number of cystoscopies performed per year.

For progression, tumour grade is the most important factor. It is also known that T1 tumours have a worse prognosis than Ta tumours. Using these factors patients with superficial bladder cancer can be divided into three groups: the lowest risk group with a single less than 3 cm Ta G1 tumour, and a recurrence rate of less than one tumour per year a high risk tumour of T1 G3, multifocal, large, highly recurrent, and CIS and other tumours of intermediate risk. Recent studies further confirm these criteria.

Infection Of Urothelial Cells

Ratliff demonstrated the role of fibronectin in the attachment of BCG to tumor cells in the late 1980s. BCG is then internalized into the tumor cells, a step that appears to be fundamental to the subsequent immune response. This was demonstrated in experiments where an antifibronectin antibody inhibited the antitumor effect of BCG. In a mouse model, BCG has been found in urothelial cells within 24 hours of instillation. This finding has been supported by in vitro studies in human bladder cancer cell lines.,

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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 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

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