BCG Treatment

What is BCG treatment?

BCG is the most commonly used drug in the treatment of bladder cancer that has not involved the muscle layer. It shows its effect by stimulating the immune system in the bladder. The stimulated immune system recognizes and destroys bladder cancer. In this way, it prevents the recurrence of bladder cancer and the progression of cancer to the deeper layers of the bladder.

How is BCG treatment done?

BCG must come into direct contact with the bladder to have an effect. For this reason, the medicine is given into the bladder with the help of a thin catheter. BCG, which comes in dry form, is diluted with physiological saline and given into the bladder in a total volume of 50 cc. The patient keeps this treatment liquid in his bladder for 2 hours and does not urinate. Meanwhile, the patient is asked to lie on his back, face down, left side and right side in a suitable environment so that BCG contacts all parts of the bladder. Before BCG treatment, water intake should be restricted to prevent dilution of the drug during its stay in the bladder. In addition, coffee should not be consumed as it has a diuretic effect.

What are the situations in which BCG treatment should not be applied?

If the patient has another disease that suppresses the immune system, other treatment methods such as intravesical chemotherapy should be considered instead of BCG. Apart from this, if the patient has a urinary tract infection, BCG treatment is postponed until after the infection has been effectively treated.

How often is BCG treatment administered?

After the decision for BCG treatment is made, BCG is administered once a week as the initial (induction) treatment of the patient, which will last for 6 weeks. The patient’s subsequent treatment varies depending on the patient’s risk group. While BCG treatment is not applied to those in the low risk group for bladder cancer, it is applied for 1 year to those in the medium risk group and for 2-3 years to those in the high risk group. BCG application for patients whose treatment will last 1 year consists of 3 doses administered one week apart after the 3rd, 6th and 12th month cystoscopy. The treatment of patients who will receive treatment for three years is; It consists of 3 doses administered one week apart after the 3rd month, 6th month, 12th month, 18th month, 24th month, 30th month and 36th month cystoscopy. Since there is no study comparing 24th month, 30th month and 36th month treatments in high-risk disease, Uropark physicians recommend that the decision on whether 30th and 36th month BCG treatment should be made should be made according to the side effects observed in the patient. Each BCG application is generally started within 1 week after the patient’s cystoscopy. You can find details about these protocols in the Non-Muscle Invasive Bladder Cancer Patient Follow-Up Card, which is filled out specifically for the patient.

What are the side effects of BCG treatment?

The most common side effect of BCG treatment is that it causes a flu-like condition. This may result in fever, chills, chills, fatigue and joint pain. These side effects usually disappear spontaneously within 2-3 days after BCG administration. In addition, since BCG treatment creates an inflammation state in the bladder that stimulates the immune system, burning sensation during urination and the desire to go to the toilet frequently may occur. This condition may also be accompanied by temporary bleeding. Although very rare, serious infections (BCG sepsis) may occur in patients due to the spread of BCG through the blood. An important finding of this condition is high fever that does not respond to antipyretics. In such a situation, please contact Uropark.

What treatments can be given when side effects of BCG occur?

When side effects of BCG treatment are observed, some chemotherapy drugs, especially “mitomycin C”, can be given to the patient into the bladder as an alternative to BCG. These drugs act directly on existing tumor cells. These drugs are administered within the framework of certain protocols, as in BCG treatment. In rare cases, the treatment period extends to more than 1 year.

What should be taken into consideration after BCG treatment?

BCG is a weakened tuberculosis bacillus (mycobacterium bovis Bacillus Calmette Guerin [BCG]) used. This microbe, which is also used as a tuberculosis vaccine, can pass from person to person. For this reason, the following issues should be taken into consideration after urinating urine containing BCG.

1- Large amounts of water must be drunk to clear BCG from the bladder.

2-When urinating, care should be taken not to splash around. For this purpose, urination can also be done while sitting.

3-Areas where urine splashes should be wiped with bleach. In addition, when urinating containing BCG treatment, undiluted bleach should be poured into the toilet (2 caps) and flushed after 15 minutes.

After urinating urine containing 4-BCG, hands should be washed thoroughly for at least 3 minutes. These four items are valid for 6 hours after BCG administration.

5-After BCG treatment, sexual intercourse should not be attempted for 48 hours and a condom should be used during sexual intercourse for 1 week.

6-Female patients receiving BCG treatment should be careful not to become pregnant and should not breastfeed until the end of treatment.