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

Bacillus Calmette-Guérin (BCG) is a type of immunotherapy used to treat bladder cancer. BCG is placed in the bladder through a catheter. This triggers the body’s immune system to stop or slow down the growth of cancer cells.1,2 Currently, BCG is the most common treatment for early-stage bladder cancer. In some cases, BCG is given after bladder surgery to remove any visible cancer. The BCG treatment is generally given weekly for 6 weeks.1 [native] Before the procedure Before beginning BCG treatment, tell your doctor about all the medicines you are taking. Some drugs can interfere with the immune response caused by the BCG treatment.3 You will likely be asked to stop drinking fluids or taking diuretics about 4 hours before the procedure. Right before the procedure, you may be asked to pee to make sure your bladder is empty. Your doctor may also provide other guidelines for you to follow.1 During the procedure First, local anesthesia is used to numb the area. Then, the doctor inserts the catheter into the canal that leads to your bladder (urethra). A catheter is a tube that allows liquids to enter or exit the bladder.1 The liquid BCG solution enters the bladder through the catheter. At this point, your doctor will clamp or remove the catheter. You will be asked to lie on your back, stomach, and each side for 15 minutes. This will make sure that the liquid BCG comes in contact with all the surfaces of the bladder. You may be asked to avoid peeing for at least one more hour.1 After the procedure BCG is a live vaccine, which means it contains a weakened form of bacteria. You should follow certain safety measures to keep others from getting infected with the bacteria.1 BCG can remain in the urine after the treatment. So, bleach the toilet after each time you pee for the first 6 hours after the treatment. Let 2 cups of bleach sit in the toilet for 15 to 20 minutes before flushing.1 When peeing, sit down on the toilet to avoid splashing. Immediately bleach anything that comes in contact with the urine for a few days after treatment. Wash your hands thoroughly after using the toilet.1 Also, you should not have sex for a few days after each BCG treatment. During the course of the treatment, use a condom during sex to avoid spreading the bacteria.1,2 BCG as maintenance therapy After your first course of BCG treatment, it may be used again as maintenance therapy. Maintenance therapy is used to prevent bladder cancer from recurring. It has also been shown to reduce the progression of bladder cancer.4 Maintenance therapy is recommended for at least 1 year after the first treatment. But this time frame and how often you have the treatment can vary. Maintenance therapy may be given 3, 6, and 12 months after the first dose. These additional doses may continue for 1 to 3 years.4 Side effects of BCG After BCG therapy, you may develop some symptoms. Most of these side effects go away within 2 days. Talk to your doctor if you are still experiencing symptoms 48 hours after the treatment.1 Common side effects of BCG include:1,2,4 A small amount of blood in your pee Mild fever Tiredness A burning sensation or pain when you pee Needing to pee more often Body aches Less commonly, BCG can cause more serious side effects or an infection. If you experience any of the following symptoms, contact your doctor right away:1-3 Fever above 100 degrees Fahrenheit Skin rash Night sweats Flu-like symptoms After BCG therapy, there is a chance the cancer will come back (recur). Your doctor will discuss a plan to monitor you for recurrence. This may include regular visits to the doctor over several years. These visits may include different types of tests that are used to detect bladder cancer.4 [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"] 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. Share your experiences: Take our In America Survey! [lead_gen showIfLoggedIn="0" campaign="shortcode_posts" source="site"]

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

What is Non-Muscle Invasive Bladder Cancer?

Starting BCG Treatments: What to Expect Before, During, and After

FDA Approves New Non-Muscle Invasive Bladder Cancer Treatment

Fighting to Keep My Bladder

The Difference Between Mitomycin and BCG

Making Treatment Decisions

Making Changes to Diet and Lifestyle

Treating T1 High Grade Bladder Cancer