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Printed at: 12:13:30 / 18-04-2021

Intravesical BCG

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Phone Contact numbers:
Urology Nursing Team
The Uro-Oncology logy Nursing Team is as follows: Emelda Moos, Laura Miles, Alex Jones, Reena Kakodkar.
Contact details ; 01908 996901 (answerphone)
Working hours: 8:30 – 16:00
Please do not hesitate to contact any of the above if you have any queries or your consultant’s secretaries.

Please read this entire leaflet carefully so that you understand what will happen to you during this treatment. If you still have questions or concerns, please feel free to ask your nurse.

None-muscle invasive bladder cancer (NMIBC) refer to disease that has not invaded the muscle layer of the bladder and is confined to the mucosa and sub-mucosa (lamina propria). Having been diagnosed with NMIBC, you will have to undergo either/or transurethral resection or biopsy. Doctors will decide after reviewing your results from these tests if you would need BCG immunotherapy as the next stage of your treatment. You can expect to remain on maintenance therapy for up to 36 months. Your BCG treatment will be given by either Urooncology Nurse specialist or a member of the Urology team.

What is BCG?
BCG stands for Bacillus Calmette Guerin and is a live vaccine normally used to inoculate TB. When it is instilled in the bladder it causes an inflammatory reaction, which destroys the cancer cells. Although this is not clear exactly how, BCG has been used very successfully worldwide in treating and preventing the recurrence of bladder cancer.

Before treatment please:
– Inform nurse if you have any allergies and the medication that you are on. Certain drugs like bone marrow depressants, immune- suppressants and or radiation as well as some antibiotics, can affect how BCG works
– Stay hydrated throughout your treatment, particularly on the day of treatment
– Do not drink fluid for at least 2 hours before the instillation so that your bladder will be empty. After 2 hours of your treatment you can drink plenty.
– If you normally take water tablets (diuretics) take them after your BCG session rather than first thing in the morning.

BCG cannot be given if:
– You have a urinary tract infection (UTI). This must be treated first
– You have blood in your urine
– You have or think you have TB (tuberculosis)
– You are HIV positive
– You have problems with your immune system

During treatment
A thin catheter is inserted into your bladder, to drain all remaining urine. BCG is then instilled directly into the bladder via the catheter. The catheter is then removed. You will be asked to hold the BCG inside your bladder for up to 2 hours.

How long does it take?
For the first treatment you will be in hospital for 2-3 hours. However, after your further treatment which would last approximately 15-20 minutes, you should be able to go straight home. You should feel well enough to drive home after the treatment, however, if you are not, please arrange for a friend/relative to drive you home.

How often is BCG given?
BCG is usually given once a week for 6 weeks. After this some people have ‘maintenance therapy’, every 6 months, where you may be given more doses. This maintenance regime may last for 3
years.

Precautions to protect you and your family
– First time you empty your bladder it is important to remember to sit down while urinating, this will minimize splashing and potential spreading of BCG
– Wash your hands with soap and water when finishing urinating
– Before flushing pour at least one cup of undiluted bleach around the inside of the toilet bowl. Leave bleach for 15 minutes before flushing. Do this every time you urinate for the first 6 hours after treatment
– If sexually active during the week after being given BCG, you must use condoms. This will lower the chance of the BCG bacteria being passed to your partner

Side effects
They are usually manageable. You may find that they are worst on the day of treatment and then go away in the next two days.
Most common side effects include:
– Fever
– Chills
– Nausea and/or vomiting
– Frequency or painful urination
– Urination at night
– Traces of blood in your urine

As BCG is an immunotherapy designed to help your own body’s immune system to fight cancer, a fever may indicate that your treatment is working. If it is persistent seek medical attention.

References
Bohle, A., Jocham, D. (2000) Intravesical Immunotherapy with Bacillus Callmette-Guerin.
Smith j.A, Labasky ATK et al (1999) Bladder cancer clinical guidelines panel summary report on the management of non muscle invasive bladder cancer (stages Ta, T1 and TIS) Journal of urology 162 p 1697-1701.