Bacillus Calmette-Guérin (BCG) therapy

Bacillus Calmette-Guérin (BCG) is a live vaccine, which is given to treat early-stage bladder cancer and helps prevent the cancer from recurring. When the medication is put into your bladder it causes inflammation. This inflammation destroys tumors and cancerous cells, therefore helping to stop the cancer from growing and spreading. Different types of vaccine therapy are also available for kidney cancer, testicular cancer, and prostate cancer, among others.

BCG instillation is done by inserting a catheter into the opening of the urethra, then into the bladder. When the catheter is in the bladder, BCG will be passed through the catheter into the bladder. The medication should be retained in the bladder for two hours to obtain the best results. The usual course of treatment is once a week for 6 weeks. Additional treatments may be needed and will be determined by your urologist.

Are there any possible side effects from the treatment?
You may experience some, usually short-lived, voiding discomfort following your treatment. The discomfort should last no more than 24 hours.

  • Pain and/or burning when passing urine
  • Blood in your urine
  • Urinating frequently
  • Flu like symptoms (joint pain, mild fever, cough, chills, fatigue

What is BCG therapy?

Back to top

Bacillus Calmette-Guérin (BCG) therapy is a type of immunotherapy treatment in your bladder. BCG treatment is given most often after bladder surgery, known as a transurethral resection of bladder tumor (TURBT), to remove any visible cancer. It is administered as a liquid drug and is made from a strain of the same bacterium that was used to create the tuberculosis vaccine.

BCG therapy is the most common intravesical immunotherapy that medical professionals use to fight early-stage bladder cancer.

What conditions are treated with BCG therapy?

Back to top

A doctor may recommend BCG therapy if you or a loved one was diagnosed with early-stage bladder cancer. BCG therapy can be effective in bladder cancers that have not spread to the bladder wall muscle, such as:

  • Carcinoma in situ bladder cancers (cancer only present in the original cells)
  • Non-muscle invasive bladder cancers (NMIBCs)

BCG therapy cannot be used to treat bladder cancer that has metastasized or spread to other parts of the body.

It may be worthwhile to speak with your doctor about current clinical trials that consider BCG therapy for fibromyalgia and diabetes. Research about the treatment’s efficacy is ongoing in these areas.

Is BCG therapy a form of chemotherapy?

Back to top

No, BCG therapy is a distinct form of treatment from intravesical chemotherapy. The treatments involve two different types of drugs. Chemotherapy drugs directly attack cancer cells. Using an immunotherapy drug through BCG therapy lets a drug harness the power found already within your immune system.

How should you prepare for BCG therapy?

Back to top

Speak directly with your healthcare provider before you receive BCG therapy. A doctor will give you a list of guidelines to prepare you for the treatment. Before receiving your therapy, a doctor will likely tell you to:

  • Avoid caffeinated beverages for four hours in advance
  • Avoid diuretics for four hours in advance
  • Urinate when you arrive for your procedure to guarantee an empty bladder

What happens during BCG therapy for cancer treatment?

Back to top

Your healthcare provider will deliver local anesthesia before beginning BCG therapy. The doctor will insert a catheter into the urethra (the hole that you urinate from) before injecting liquid BCG solution into the bladder. There are several pieces of information that your doctor should share with you about the post-procedure process and overall treatment plan. Make sure to ask:

  • How long do you hold BCG in the bladder? The time frame that you will hold BCG solution in your bladder is two hours.
  • What does BCG do to the bladder? Once the solution enters the bladder, your immune system cells start attacking the bladder’s cancer cells.
  • What is the usual BCG treatment schedule? Induction therapy, or initial BCG therapy for cancer treatment, is weekly for six weeks. A healthcare provider may prescribe BCG maintenance therapy if the treatment is effective. Maintenance therapy takes place once per week for three weeks. It is delivered at the three-, six-, and 12-month marks. It may continue for up to three years in some patients.

BCG therapy often looks different for patients. It is best to discuss your treatment plan with your doctor who is familiar with your medical records and health history.

Is BCG therapy contagious?

Back to top

Yes, BCG therapy involves drugs that contain live bacteria. Your doctor will walk you through how to reduce the risk of contamination or passing bacteria on to other people. For six hours following your BCG therapy, you should:

  • Avoid public toilets
  • Drink fluids to dilute your urine
  • Urinate while sitting to avoid splashing
  • Add 2 cups of undiluted bleach to the toilet after urinating, close the lid, then wait for 15 to 20 minutes before flushing
  • Wash your clothes alone and immediately in a washing machine if you have urinary incontinence (loss of bladder control)
  • Pour bleach on any incontinence pad, allow it to soak, then discard it in a plastic bag
  • Refrain from having sex for a few days after each session
  • Use a condom during the entire course of BCG therapy treatment

If you have any questions or want to confirm that you are taking all of the essential precautions, speak with your healthcare provider about specific guidelines and best practices.

What are the advantages of BCG therapy?

Back to top

BCG therapy is the most effective treatment for early-stage bladder cancer when you receive it in combination with a transurethral resection of bladder tumor. BCG therapy can help slow the growth of a tumor. The treatment plan can reduce the likelihood of you needing to undergo a future cystectomy (a partial or complete removal of the urinary bladder).

What are BCG therapy side effects?

Back to top

Some side effects are standard within the first 24 hours of receiving BCG therapy. Common side effects to keep an eye on include:

  • A small about of blood in your urine
  • Low-grade fever (99-100 degrees Fahrenheit)
  • Fatigue
  • A burning sensation while urinating
  • Frequent urination
  • Joint and/or muscle pain

 

A healthcare provider can prescribe medications to manage any of these side effects. Taking an over-the-counter pain reliever can also help to reduce fevers and ease short-term discomfort.

Less common complications from BCG therapy are:

  • Skin rash
  • Fever higher than 101.3 degrees Fahrenheit
  • Nausea and vomiting
  • Bladder spasms
  • Loss of bladder control
  • Inability to urinate
  • Urinary tract infections (UTIs)
  • Inflammation of the testicles
  • Bladder contracture (when the bladder muscles thicken or scar)
  • Ureteral obstruction
  • Necrosis (cell death)
  • Chills and/or severe shivering
  • BCG sepsis (when BCG solution enters the bloodstream)
  • Neutropenia (low white blood cells)
  • BCG-induced hypersensitivity pneumonitis (lung inflammation)
  • Hepatitis

 

Any development of severe pain, a high fever, or signs of infection should not be ignored. Call your healthcare provider immediately if you notice these side effects. Immediate follow-up with your doctor can help you to avoid worsening side effects.

What is the outlook for BCG therapy?

Back to top

The recovery time and outlook for each patient of BCG therapy is different. It is always a good idea to reach out to your doctor if your recovery time looks different than they anticipated or you have any concerns.

  • How long is the recovery after each BCG therapy session? Most side effects from BCG therapy are gone after two to three days. Severe symptoms, or ones that last for more than 72 hours, should be addressed immediately with a healthcare provider.
  • When can you return to work or school? The recovery time is often one to two days. Talk to your healthcare provider about what timeline is best for your recovery.
  • Can bladder cancer return after BCG treatment? Unfortunately, bladder cancer can potentially return after BCG therapy, like most cancers. Cancer statistically recurs in as many as 40% of patients who undergo BCG therapy treatment. It is worth noting that a recurrence of cancer does not necessarily mean that it will advance.

It is rare that aggressive bladder cancer develops after receiving BCG therapy. A healthcare provider may recommend surgery to remove your bladder if that situation does arise.

Categories

Archives