Must-Reads for Anyone with Non-Muscle Invasive Bladder Cancer

Bacillus Calmette-Guérin (BCG) is an immunotherapy used to treat bladder cancer. BCG treatment is made from a bacterium and is also used as a vaccine for tuberculosis.1,2 It is known as a “live” vaccine, which means it is a very weakened version of the original bacteria. BCG is placed in the bladder through a catheter and triggers the body’s immune system to stop or slow the growth of cancer cells. BCG causes inflammation in the bladder, which is a sign that the immune system is fighting off cancer. [native] BCG is a fairly non-invasive treatment; patients come into a doctor’s office to receive the treatment and are able to go home the same day. BCG is usually given once a week for 6 weeks following another common bladder cancer treatment: the transurethral resection of bladder tumor (TURBT) procedure. BCG can also be given as maintenance therapy over a period of up to 3 years. Any new treatment or procedure can be confusing and scary. Knowing what to expect can hopefully help to reduce anxiety. Before Your doctor will give you a set of instructions before your BCG treatment to help you prepare for the procedure.1 In general, patients are usually told to limit their fluid intake for 6 hours before treatment. Drinking less will ensure that less urine is produced, and this will prevent the BCG treatment from being diluted in the bladder. Patients may also be asked to pass urine right before the procedure to make sure the bladder is empty. You should be able to eat as you normally would before your BCG treatment but always check with your doctor for specific instructions. Your doctor may also give you additional guidelines that cover: Taking medications Pregnant or breast feeding mothers Flu or flu shot, shingles or TB Bleeding conditions During During the procedure, a catheter is placed in the urinary bladder through the urethra. A local numbing medication, often a gel, may be used for the catheter insertion.1,2 It is generally not considered a painful procedure, though some may find it uncomfortable. Any urine remaining in the bladder will be drained and then a BCG solution will be inserted into the bladder next to the tumor and should remain for two hours. The catheter is normally removed after the BCG is placed into the bladder, and patients can get up and walk around during the waiting time. If the catheter is not removed for some reason, it is clamped to keep the BCG in the bladder. Patients are asked not to urinate for the two hours waiting time. Most people can travel independently to the doctor for the procedure, but it may be helpful to have another person accompany you to help pass the time. After After the BCG has been in the bladder for two hours, patients who have had the catheter removed are asked to urinate.1,2 Those who have had the catheter remain inserted during the waiting time will have the BCG drained before the catheter is removed. After the BCG is drained from the bladder, patients can resume drinking fluids normally. Because BCG is a live vaccine, there are some important safety measures to keep in mind that your doctor can explain. BCG can remain in urine for 6 hours after your treatment, so each time you urinate, you should bleach the toilet in your home to neutralize the vaccine. If you are using a shared bathroom, you should make sure that no one uses the toilet directly after you until the bleach can take effect. It’s important to be mindful of small children and make sure you communicate with the members of your household about your treatment. Hand-washing and hygiene is important during your treatment and your doctor will provide specific safety instructions for after your treatment. Additionally, your doctor may advise you to refrain from oral sex or sexual intercourse for a few days after each BCG treatment. If you have any questions, make sure to ask your doctor. BCG maintenance therapy After the initial course of BCG treatment, it may be used again as maintenance therapy.1,2 Maintenance therapy is used to prevent bladder cancer from recurring and has been shown to reduce the frequency of recurrence and progression of bladder cancer. Treatment protocol intervals may vary, so patients could receive additional BCG treatments every 1, 3, or 6 months over a period of 1 to 3 years. 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. Starting BCG for the first time? Would you like to talk to others in the bladder cancer community about BCG treatment? Reach out in our forums. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Occasionally, there is some confusion within the bladder cancer community between two common treatments: Bacillus Calmette-Guerin (BCG) and Mitomycin. They are both intravesical therapies, meaning that they are treatments that are delivered in liquid form directly into the bladder through a catheter, rather than by mouth or through an IV line. The confusion between the two is understandable since the experience of receiving either of these treatments is very similar! How does intravesical therapy work? When drugs are directed to the cells that line the inside of the bladder, they can attack the cancer growing there without causing damaging effects to the rest of the body.1 Intravesical therapies are typically recommended for people who have non-muscle invasive bladder cancer or who have an increased risk of disease recurrence after surgery.2 Intravesical therapy is commonly used after a transurethral resection of bladder tumor (TURBT) procedure is done to remove most or all of a bladder tumor. It is generally done quickly, between 6 and 24 hours post-procedure. The objective of quickly following up a TURBT with intravesical therapy is to kill any cancer cells that may remain in the bladder following surgery.1 Cancer cells beyond the bladder lining are not impacted by intravesical therapy. There are two common treatment approaches used in intravesical therapy, and they each have different benefits and side effects. One uses traditional chemotherapy, and the other uses immunotherapy. BCG is a type of immunotherapy Immunotherapy treatment uses a person’s own immune system to attack the cancer cells. It is the most common approach to treat bladder cancer when discovered in the early stages. BCG is a type of immunotherapy that has the effect of activating cells in the immune system to attack cancer cells in the lining of the bladder. BCG only works when it comes in direct contact with tumor cells.1,3 Maintenance therapy Because bladder cancer is often a recurring condition, maintenance therapy may be recommended for patients with a type of bladder cancer linked to a higher risk of recurrence. It involves long-term periodic BCG treatments after the initial treatments. It is beneficial in reducing the chance that bladder cancer cells will regrow. Mitomycin is a type of chemotherapy Mitomycin is the drug most often prescribed for intravesical chemotherapy. Mitomycin is a cytotoxic antibiotic that inhibits DNA synthesis in bladder cancer cells.2 This means that it attacks and kills active cancer cells and impedes their ability to grow and replicate. It is delivered into the bladder through a soft catheter and can be administered in two ways. One option is to use the drug in the normal way. Another form of the treatment is called electromotive mitomycin therapy, whereby the inside of the bladder is heated.1,4 This treatment approach has been demonstrated to have improved effectiveness. Intravesical chemotherapy is most often used when intravesical immunotherapy has not been effective. It is rarely used for more than one year.1 [poll nexus_id="1449"] Side effects of intravesical therapies BCG immunotherapy can be more toxic than Mitomycin chemotherapy. Common side effects of BCG include flu-like symptoms, fatigue, fever, chills, or bladder irritation. Recurring use of BCG increases the likelihood of more severe side effects like greater bladder irritation and inflammation and a burning feeling in the bladder and blood in urine.1 Intravesical administration helps to reduce and avoid many of the side effects usually linked to chemotherapy. Additionally, there are fewer maintenance side effects of mitomycin chemotherapy than for BCG. Side effects of mitomycin are irritation, a burning sensation in the bladder, and blood in urine. Your physician will provide instructions on any special care requirements and advice on how to manage treatment side effects. Intravesical BCG and Mitomycin are contraindicated under certain conditions. Be sure to provide a complete medical history to your medical team before beginning treatment. [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"]

Must-Reads for Anyone with Non-Muscle Invasive Bladder Cancer

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