BCG treatment for non-invasive bladder cancer

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Christopher Fisher
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1 BCG treatment for non-invasive bladder cancer This information is an extract from the booklet Understanding non-invasive bladder cancer. Non-invasive bladder cancer is only in the inner lining of the bladder and has not spread into the muscle layer of the bladder. You may find the full booklet helpful. We can send you a free copy see page 5. We have included a comment from someone affected by bladder cancer, which you may find helpful. This has been taken from our online community (macmillan.org.uk/community). Contents When BCG is used How it s given Side effects BCG is a vaccine used to prevent tuberculosis (TB), but it s also an effective treatment for some non-invasive bladder cancers. It s given directly into the bladder (intravesical). BCG is a type of immunotherapy drug and doctors aren t sure exactly how it works in bladder cancer. It may make the bladder react in a way that triggers the immune system (helps fight infection and disease) to get rid of cancer cells. When BCG is used BCG helps prevent the cancer from coming back in the bladder lining, and also reduces the risk of it becoming invasive. It s usually given when there is a high risk that the cancer will come back and grow into the bladder muscle (become invasive). Questions about cancer? Ask Macmillan Page 1 of 5

2 The risk of the cancer coming back depends on different factors. This includes the stage of the cancer. Non-invasive bladder cancer is either CIS (see below) or stage Ta or T1 (T stands for tumour). Ta is when the tumour is only in the inner layer of the bladder lining, while in T1 it has started to grow into the tissue beneath the bladder lining. The grade of the cancer (how the cancer cells look under the microscope) and how many tumours there are, are also taken into account when considering a person s risk. There may be a higher risk in people who have: Carcinoma in situ (CIS) This can t usually be removed completely with surgery because it s flat and often widespread in the bladder lining. Ta and T1 cancers that are grade 3 (high-grade). T1 cancers that are grade 2 and larger than 3cm (1in) across OR when there are several tumours in the bladder. The urologist or cancer specialist will explain why BCG is the most appropriate treatment for you. There needs to be a gap of at least two weeks after you ve had surgery before BCG treatment can be given. You ll usually have your treatment with BCG weekly for six weeks, followed by a six-week break, and then once a week for 1 3 weeks. If the BCG treatment is working well, it can then be given weekly for 1 3 weeks every six months. This is called maintenance therapy and it can be given for up to three years. Treatment times vary and your doctor will explain what is appropriate in your situation. I ll be having BCG for the next two years apparently, followed by ops for biopsies, but if it keeps it away then that s great. Deb Page 2 of 5 Questions about cancer? Ask Macmillan

3 How it s given Treatment with BCG is given to you in the hospital outpatient department. The treatment takes up to three hours and you can usually go home as soon as it s finished. You re usually asked to limit the amount of liquid you drink before the treatment. This helps to increase the concentration of BCG in your bladder. Plus, drinking too much beforehand can make your bladder feel uncomfortably full. If you normally take water tablets (diuretics), take them later in the day. Your nurse or doctor will give you advice about preparing for your treatment. When you re lying down and comfortable, the nurse will put a fine tube (catheter) into your bladder. The BCG is then put directly into your bladder through the catheter. For the first 15 minutes you ll have to lie on your front, but after that you can get up and walk around. You need to try not to pass urine for two hours afterwards. This can be difficult but the aim is to give the BCG treatment time to work. Sometimes the catheter is left in and clamped to keep the drug in your bladder for the next two hours. When the treatment is over, you can go to the toilet. If you have a catheter, the BCG is drained into a urine bag before the catheter is removed. After your treatment, you ll need to take some precautions for the next six hours. This is because BCG is a live vaccine and other people shouldn t be exposed to it. The main thing to avoid is urine splashing on the toilet seat or getting urine on your hands. To avoid splashing, men might find it easier to sit down when they re using the toilet. After you ve passed urine, you should put undiluted bleach into the toilet bowl to destroy any vaccine. Leave it for 15 minutes and then flush the toilet with the lid down. Your nurse or doctor will give you more advice about this. Questions about cancer? Ask Macmillan Page 3 of 5

4 Side effects Because BCG goes directly into the bladder, most side effects are linked with the bladder. The most common effects are: needing to pass urine often pain when you pass urine blood in the urine flu-like symptoms such as tiredness, general aching and a raised temperature. These effects should settle down within a day or two. If they don t get better after this time, contact your doctor. It s important to drink lots of fluid, which will help flush the drug out of your bladder and reduce some of the side effects. Taking painkillers will also help. Rare side effects can include a continuing high temperature (fever), pain in your joints and a cough. If you have any of these symptoms, or feel generally unwell, contact your doctor immediately. It could be a sign of a more serious infection due to the BCG that needs urgent treatment. If this happens, you ll be treated with antibiotic drugs used to treat TB. Protecting your partner Men should use a condom if they have sex during the first week after having BCG treatment. If you re a woman having the treatment, your partner should use a condom during this time. This protects your partner from any vaccine that may be present in semen or vaginal fluid. Contraception It s not known how BCG may affect an unborn baby, so it s not advisable to become pregnant or father a child while having it. It s important to use effective contraception during treatment and for six weeks afterwards. You can discuss this with your doctor or specialist nurse. Page 4 of 5 Questions about cancer? Ask Macmillan

5 More information and support Cancer is the toughest fight most of us will ever face. But you don t have to go through it alone. The Macmillan team is with you every step of the way, from the nurses and therapists helping you through treatment to the campaigners improving cancer care. We are Macmillan Cancer Support. To order a copy of Understanding non-invasive bladder cancer, visit be.macmillan.org.uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED FEBRUARY 2013 Planned review in 2015 Questions about cancer? Ask Macmillan Page 5 of 5

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