BCG treatment for bladder cancer

You have been diagnosed with cancer of the bladder mucosa. You have been cauterized or scraped using an instrument that has been passed through the urethra (the urinary canal). Even if all traces of cancer have been removed, microscopic cancer cells may have been left in the bladder and new tumors may develop. Your doctor has recommended BCG treatments to remove any remaining cancer cells and reduce the risk of recurrence.

BCG (Bacillus Calmette Guerin) is a vaccine composed of bacteria, originally developed to prevent tuberculosis. When brought into contact with bladder cancer, this vaccine stimulates a reaction that causes the destruction of cancer cells and helps prevent recurrence. The experience of many thousands of men and women has been shown to be effective in controlling bladder cancer.
Generally, your urologist will recommend a series of BCG treatments once a week for six weeks, starting a few weeks after the surgery. Treatments will be administered at your hospital or clinic. Your doctor may recommend additional treatments a few months after the first run. Sometimes, these maintenance treatments can continue for a few years.

Before your treatments

BCG works best when it is kept at its maximum power in the bladder. To prevent dilution of BCG with urine, it is best to limit your fluid intake to less than 250 mL (1 cup) during the four hours before each treatment. Diuretics (“pills for water”) increase urine production and have the same diluting effect. They should be taken two hours after your treatment rather than before your treatment.
Tell your doctor or nurse before your treatment if:

  • You are pregnant
  • Your immune system is weakened by a disease or a drug such as steroids
  • You have a bladder infection, often indicated by increased urinary frequency and urgency, urinary burns and cloudy and foul-smelling urine
  • You have had a heart valve replacement
    When a difficulty is encountered during catheter insertion, the BCG treatment may be postponed for one week. The introduction of BCG into blood vessels or tissues can cause serious illness.

BCG treatment

Your doctor or nurse will administer your BCG treatments. A thin tube (catheter) is pushed into the urethra into the bladder. After drainage of all the urine, a small amount of BCG solution is put into the bladder. The catheter is then removed. You will be notified when you can leave.

After your treatments

BCG must stay in contact with the bladder mucosa to be more effective. This can be achieved by lying on your stomach, back and on each side for 15 minutes at a time for one hour. It is best to avoid urinating for about two hours after each treatment.

When it’s time to urinate, you should urinate sitting to avoid splashing. BCG is a live vaccine that can cause harm if it comes into contact with other parts of the body. After emptying the bladder, the BCG must be neutralized. This can be done by adding bleach to the urine in the toilet.

For the first six hours after each treatment, pour 250 ml (1 cup) of bleach into the toilet after each urination. Allow the bleach to work for 15 minutes to neutralize the BCG before flushing. Your bathroom should be well ventilated since the mixture of urine and bleach can sometimes emit strong vapors. Wash your hands and genitals carefully after each urination for the first six hours after treatment.
Contact with urine should be avoided for the first six hours after each BCG treatment. Skin contact should be washed thoroughly with soap and water. Splashes of urine should be wiped with a strong disinfectant or bleach.

Sexual intercourse should be avoided for at least 24 hours after BCG treatment.

After each treatment, it is not uncommon to have a headache, to have a temperature (less than 38.5 ° C or 101 ° F), to have a lack of appetite and a drop in energy for a period of up to three days. Acetaminophen (TylenolTM) will often help to reduce these symptoms. More frequent and urgent urination with burning is normal for a few days. These effects can be treated, if necessary, with phenazopyridine (PyridiumTM) available on prescription.

Monitoring

After your BCG treatment series, you should have a new evaluation to see the effects of the treatment. Urine samples could be examined for the presence of cancer cells (urinary cytology) and the bladder could be examined visually with an instrument passed through the urethra (cystoscopy).

Other BCG treatments may be recommended. In some cases, additional treatments including surgery may be required to control the cancer.

Contact your doctor or nurse if:

  • Your urine contains a lot of blood. It is normal to have a small amount of blood in your urine after your treatment but it should be clear after 3 days.
  • You have chills and fever over 38.5 ° C (101 ° F)
  • You have persistent nausea, vomiting or diarrhea
  • You have new joint pain that lasts more than three days after your BCG treatment
  • You with itching or develop cough.