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.
What Is Bcg Treatment
Some people may know BCG as a vaccine used to prevent tuberculosis . But it is also a main treatment for non-muscle-invasive bladder cancer.
BCG is a type of immunotherapy drug. Immunotherapy drugs encourage the bodys immune system to fight cancer cells. For bladder cancer, BCG is given directly into the bladder . This can make the bladder react in a way that makes the immune system get rid of cancer cells.
Remission And The Chance Of Recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having no evidence of disease or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place , nearby , or in another place .
When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options.
People with recurrent cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
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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.
Treating Bladder Cancer With An Engineered Virus
New funding will help bring the therapy one step closer to clinical use
David Evans aims to use an oncolytic virus he developed as a treatment for non-muscle invasive bladder cancer.
Viruses are commonly associated with illness. Whether it is a nasty stomach bug or a bout of influenza, most people do not equate introducing a virus to the body with positive outcomes. David Evans, professor and vice-dean of research at the Faculty of Medicine & Dentistry, is not like mostpeople-he sees viruses as a potential cancer-fighting treatment.
Evans aims to use a virus he engineered to improve the treatment of non-muscle invasive bladder cancer . The virus is an oncolytic virus, which means it has been modified to selectively kill rapidly-dividing cancer cells while remaining safe for surrounding healthy cells.
Bladder cancer is the sixth most common cancer in Canada. Currently NMICB is treated surgically surgeons remove the cancer by cutting it or scraping it out of the bladder. Chemotherapy, and/or intravesical administration of Bacillus Calmette-Guerin , a vaccine used for tuberculosis, may also be used.
Unfortunately, there is a high rate of recurrence of NMICB. Patients need to be monitored frequently and, if the cancer returns, treatment becomes increasingly more aggressive.
“There’s an unmet need,” says Evans. “We really need better ways to treat this disease we got a clue from the use of the pro-inflammatory BCG vaccine, that a virus could be used as a form of treatment.”
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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 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.|
Modified Tuberculosis Vaccine As A Therapy For Bladder Cancer
by Markus Berninger, Max Planck Society
The human immune system can recognize and eliminate not only germs but also cancer cells. This is why treatments with weakened germs can help the immune system in its fight against cancer. Researchers at the Max Planck Institute for Infection Biology in Berlin have genetically modified the tuberculosis vaccine BCG in a way that it stimulates the immune system more specifically. Consequently, the new vaccine offers much greater protection against tuberculosis. A clinical study with patients suffering from cancer of the bladder has now shown that a therapy with VPM1002 could successfully prevent the recurrence of tumors in almost half of the patients who had not responded previously to the BCG therapy. The results could lead to the early approval of the drug for the treatment of cancer of the bladder so that as many patients as possible can profit from this quickly.
At the end of the 19th century, doctors observed that the tumor in some cancer patients shrank if the patients suffered from a bacterial infection with a high fever. These findings sparked interest in immunotherapy for cancer. Immunomodulatory treatments can specifically stimulate the immune system. As a result, the body’s own immune system is supported in its fight against the tumor, leading to a reduction in the size of the tumor.
Bladder treatment with weakened germ
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Tb Vaccine Being Used To Treat Bladder Lining Cancer
A vaccine for tuberculosis is now being used to treat early, potentially aggressive cancers of the lining of the bladder. These superficial, or shallow, cancers can progress to invasive forms that burrow into the bladder muscle and then spread to other parts of the body, becoming incurable.
The standard approach to one of the more aggressive types of superficial bladder cancer, carcinoma in situ , has been to surgically remove the bladder if the cancer cannot be eradicated quickly by more conservative means, said Dr. John A. Provet, a urologist at New York University Medical Center.
Previous medications instilled directly into the bladder for this type of cancer, also referred to as transitional cell carcinoma, have had limited success rates. The new treatment using bacille Calmette-Guerin may eradicate CIS in 60% of the cases.
BCG was first created in 1906 as a vaccine against human tuberculosis. It is a laboratory-weakened strain of a bacterium that causes TB in cows.
BCG solution is instilled directly into the bladder through a catheter, or soft tube. The treatment is generally performed in a urologists office. The normal course of therapy is one infusion a week for a period of six to 12 weeks. The bodys immune system reacts by attacking the foreign micro-organisms that have entered the bladder.
In the past, it was often necessary to sacrifice the bladder to save a life, concluded Provet. Now with BCG, it should be increasingly possible to save the bladder.
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.
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What Other Drugs Will Affect Bcg
If you have an infection that must be treated with an antibiotic, you may need to stop receiving BCG for a short time. Antibiotics can make BCG less effective and should be avoided during your treatment with BCG. Follow your doctor’s instructions and be sure to tell any other doctor who treats you that you are receiving BCG.
Tell your doctor about all your other medicines, especially
Researchers Eye Cancer Drug Bcg As Potential Covid
The frantic search for ways to stop, prevent and treat COVID-19 has put the spotlight on a decades-old drug originally developed for tuberculosis , but currently used to treat bladder cancer. The Bacillus Calmette-Guerin vaccine, one of the most widely administered vaccines in the world to prevent TB, is now being researched as a potential COVID-19 vaccine. While the research into BCG has generated headlines worldwide, it may take some time to determine whether the drug is safe and effective against the virus, an often-painstaking process for any potential treatment.
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What Researchers Are Finding
Doctors from New York City to Melbourne, Australia, are racing to conduct research and collect data on BCGs potential use in abating the COVID-19 pandemic.
In Australia, doctors at The Murdoch Childrens Research Institute are leading a clinical trial, injecting up to 4,000 health care workers with the vaccine, to determine whether the drug helps protect them from the virus. Researchers say they hope to see a reduction in the prevalence and severity of COVID-19 symptoms.
At the Johns Hopkins Bloomberg School of Public Health, researchers have determined that the COVID-19 mortality rate in countries where the BCG vaccine is given routinely to protect against TB are lower than in countries where the vaccine is not used. And Scientists at the New York Institute of Technology, College of Osteopathic Medicine, made similar observations, noting that Italy and the United States, where COVID-19 cases and deaths have soared, do not routinely vaccinate their children with BCG. “The combination of reduced morbidity and mortality makes BCG vaccination a potential new tool in the fight against COVID-19, they wrote. Researchers are uncertain of exactly how or why BCG may work against the new virus. While TB and COVID-19 are both primarily respiratory ailments, TB is caused by bacteria, while COVID-19 is caused by a virus.
Immunotherapy For Bladder Cancer
Some people with bladder cancer have immunotherapy. Immunotherapy helps to strengthen or restore the immune systems ability to fight cancer.
You may have immunotherapy to:
- kill bladder cancer cells
- stop bladder cancer cells from growing and spreading
- lower the risk that the cancer will come back
- help keep the cancer from coming back after it has already been treated
- control symptoms of bladder cancer
Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of immunotherapy. You may also receive other treatments.
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Study Setting And Data Collection
This study was performed at the University Hospital 12 de Octubre , a 1300-bed tertiary care center with a reference population that ranged from 536,450 to 405,577 inhabitants during the study inclusion period . By means of a retrospective search of the institutional database we identified a total of 315 patients who received 1 instillations of intravesical BCG as adjunctive treatment of superficial bladder cancer throughout this period. We excluded 59 patients due to the lack of clinical data, so 256 patients were finally included. All the patients were followed for at least 6 months after the last intravesical instillation. The need for specific informed consent was waived by the institutional review board due to the strictly retrospective and noninterventional nature of the investigation.
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
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What To Know About Bcg For Bladder Cancer
Did you know May is Bladder Cancer Awareness Month? It’s a time to raise extra awareness and promote facts about this disease. Education and raising awareness about bladder cancer is an important part of moving closer to a cure.
If you or a loved one is diagnosed with bladder cancer it can be frightening. However, your doctor and medical team are there to help you.
Talk with your healthcare team about all the available forms of treatment. They will tell you about possible risks and the side effects of treatment on your quality of life.
Your options for treatment will depend on how much your cancer has grown. Your urologist will stage and grade your cancer and assess the best way to manage your care considering your risk. Treatment also depends on your general health and age. Visit our condition article to learn more about treatment options for bladder cancer.
Renal Tuberculosis With Other Renal Diseases/lesions
There have been a number of case reports of TB associated with various forms of glomerulonephritis, including a case report of miliary TB complicated by focal proliferative glomerulonephritis, in which immune deposits were present, but no granulomas.
Imaging of renal tuberculosis may occasionally be complicated by the concurrent presence of tumors, usually adenocarcinomas, although transitional cell carcinoma has also been reported. This association is purely coincidental, although it has been hypothesized that renal tumors may be responsible for reactivation of dormant TB foci. TIN occurring together with leukemic infiltration has also been reported.
Renal TB has also been noted in native adult polycystic kidneys, in immunocompromised transplant recipients in association with renal replacement lipomatosis, and in horse-shoe kidneys.
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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
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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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.