Your Treatment with Bacillus Calmette- Guérin (BCG) Patient Information
Introduction Your consultant has prescribed BCG for the treatment of your bladder tumour. This booklet does not replace the discussion between you and your consultant but has been written to help you understand your treatment. If you have any questions or concerns, please do not hesitate to contact your clinical nurse specialist (also called a key worker). What is BCG? BCG stands for Bacillus Calmette-Guérin. BCG is a live Tuberculosis (TB) vaccine which has been weakened to reduce the risk of infection, but will stimulate your body s immune system to fight the cancer cells. This is known as immunotherapy. There is more than one drug-company that produces BCG. You will be given written information about the specific brand of BCG that you will receive. What you need to know about your treatment You can eat normally before and after your treatment, however, you should reduce your fluid intake for two to four hours prior to treatment. You should take any of your regular medications as normal unless otherwise instructed. You can drive yourself to the hospital and home again or travel on public transport. At your first appointment you will be met by a nurse who will explain the treatment to you and answer your questions. You will be asked to sign a consent form. You will be taken into a treatment room. You will be asked to lower your clothes below your waist and lie on your back on a treatment couch. After cleansing with an antiseptic agent, a small tube called a catheter will be inserted into your urethra (water pipe). The nurse will then instill the BCG treatment into your bladder, via the catheter, which will then be removed. The treatment consists of 50 ml of solution, which you will need to hold in your bladder for two hours (50 ml would fill approximately one third of a tea cup). 1
If you cannot hold the treatment for two hours, do not worry, let the nurse know. After getting dressed, you may go home if you wish and pass the treatment out in your own toilet. If you cannot get home in time, or are worried about travelling with the treatment in your bladder, please discuss this with your nurse. Please make a note of any symptoms you experience during the week between treatments and tell the nurse at your next visit. Once your catheter is removed you will be given a date for your appointment the following week. Benefits The benefits of the treatment are that it may reduce the risk of the tumour recurring or progressing. Risks There is a very small risk that you may develop a severe illness due to the BCG vaccine entering your system. If this happens, you will need immediate drug treatment. The side effects section of this leaflet gives you more information about symptoms you should report immediately. Your doctor or nurse specialist will discuss the likelihood of this risk with you before your treatment starts. You and your partner should ensure a condom is used during sexual activity, throughout the course of treatment, and for seven days after the last instillation. This is to avoid accidental BCG infection of your partner. Women are advised to use additional birth control to avoid pregnancy during treatment. If you are planning to become pregnant, please seek advice from your consultant. The risks of not having the treatment are that the tumour may recur or progress. There are different manufacturers that produce BCG. You will be given specific information about their product, including the risks and benefits. Alternatives There is no proven alternative drug treatment. 2
During treatment important information Because BCG contains a live agent, you will need to take precautions when you pass urine for the first six hours after the treatment has been given. Please follow these instructions carefully: Once you have held your treatment in your bladder for two hours you can then pass urine down the toilet. You must always pour bleach around the toilet bowl each time you pass urine and leave it for at least 15 minutes before flushing the toilet. You must wash your hands and genitalia thoroughly with soap and water each time you pass urine. You must continue to do this for the next six hours. If possible, children under the age of two years old should not come into contact with the adult on the day of treatment. If there is anyone at home on immuno-suppressive treatment such as after a transplant, please tell the nurse before the treatment starts. If you are sexually active, you and your partner should use a condom whilst you are still receiving treatment. It is very important that you drink plenty of fluids over the first 24 hours after passing the treatment out from your bladder. This will help to reduce any irritation. You may find it easier holding the treatment in your bladder if you restrict your fluid intake for two to four hours before each treatment. You are advised not to have a flu vaccination whilst having this course of treatment. Please discuss this with your clinical nurse specialist. Side effects of BCG It is common to experience flu like symptoms for the first 24 to 48 hours after treatment. Taking two paracetamols every four to six hourly should help. If the symptoms persist longer than 48 hours, this may indicate that BCG vaccine has entered your system and you will need immediate drug treatment. Symptoms to report immediately to your clinical nurse specialist or GP are: Shivering longer than 48 hours after treatment. Joint pains. Cough. High temperature (above 39 degrees centigrade for 12 hours, or 38.5 degrees centigrade for more than 48 hours). 3
Difficulty breathing, shortness of breath, wheezing, rashes and/or swelling of the face. These are signs of an allergic reaction and must be dealt with urgently. Other symptoms to report to your clinical nurse specialist are: Blood in your urine (the treatment cannot be given if there is visible blood in the urine). Passing urine more frequently than every 2 hours longer than the first 48 hours after treatment. Pain on passing urine. Nausea or vomiting. After your courses of treatment follow up Following completion of your treatment we will arrange for you to have your bladder checked again with a small, flexible, fibre-optic telescope. This is called a cystoscopy. This will take place within six weeks from the end of the treatment and may be performed under a local anaesthetic (flexible cystoscopy) or under general or spinal anaesthetic so that biopsies can be taken. You will be notified which one you will have. Your consultant may require you to have further instillations of the BCG. This is called maintenance therapy and usually consists of three treatments at weekly intervals. You will be informed if you need this. If you need further help or advice, please do not hesitate to contact your clinical nurse specialist. Local support groups Please visit on our website for details of local support groups: http://www.birminghamcancer.nhs.uk. Local sources of further information You can visit any of the health/cancer information centres listed below: Heart of England NHS Foundation Trust Health Information Centre Birmingham Heartlands Hospital Bordesley Green Birmingham B9 5SS Telephone: 0121 424 2280 4
Cancer Information and Support Centre Good Hope Hospital Rectory Road Sutton Coldfield B75 7RR Telephone: 0121 424 9486 Sandwell and West Birmingham Hospitals NHS Trust The Courtyard Centre Sandwell General Hospital (Main Reception) Lyndon West Bromwich B71 4HJ Telephone: 0121 507 3792 Fax: 0121 507 3816 University Hospital Birmingham NHS Foundation Trust The Patrick Room Cancer Centre Queen Elizabeth Hospital Edgbaston Birmingham B15 2TH Telephone: 0121 697 8417 Walsall Primary Care Trust Cancer Information & Support Services Challenge Building Hatherton Street Walsall WS1 1YB Freephone: 0800 783 9050 About this information This guide is provided for general information only and is not a substitute for professional medical advice. Every effort is taken to ensure that this information is accurate and consistent with current knowledge and practice at the time of publication. We are constantly striving to improve the quality of our information. If you have a suggestion about how this information can be improved, please contact us via our website: http://www.birminghamcancer.nhs.uk. This information was produced by Pan Birmingham Cancer Network and was written by Consultant Surgeons, Clinical Nurse Specialists, Allied Health Professionals, Patients and Carers from the following Trusts: 5
Heart of England NHS Foundation Trust Sandwell and West Birmingham NHS Trust University Hospital Birmingham Foundation Trust Walsall Hospital NHS Trust We acknowledge the support of Macmillan in producing this information. Pan Birmingham Cancer Network 2010 Publication Date: June 2010 Review Date: June 2013 6