Bacillus Calmette-Guerin (BCG) Treatment

BACILLUS CALMETTE-GUERIN (BCG) TREATMENT

BCG (Bacillus Calmette-Guerin) is an anticancer biologic response modifier.

Bacillus Calmette-Guerin (BCG) is an inactivated form of the tuberculosis bacteria. It works against cancer as a biologic response modifier. Biological response modifiers are substances that have no direct antitumour effect but are able to trigger the immune system to indirectly affect tumours.

BCG is thought to bring about an immune response in the bladder by triggering an inflammatory reaction in the bladder. This reaction brings disease-fighting white blood cells and cytokines (proteins produced by one cell to influence the behaviour of other cells) to the bladder. The immune system cells then fight directly against the tumour cells. The cytokine response changes the environment in the bladder that may inhibit future tumour growth and progression.

HOW IS BCG GIVEN?

  • BCG is given by intravesical infusion. This means it is given directly into the bladder through a urinary catheter. The urinary catheter is inserted through the urethra (the tube which carries urine from the bladder to the outside of the body). The BCG solution is injected into the catheter and the drug is prepared as a liquid (approximately ¼ cup).
  • BCG treatment is given as an outpatient procedure.
  • The treatments are usually given on a weekly basis for 6 weeks. Your doctor will determine your exact treatment schedule and dose.
  • Then you will have Maintenance BCG therapy usually every 3 months for 3 weeks for the next year.

WHAT DO I NEED TO DO BEFORE THE TREATMENT?

  • A urine sample may be sent for testing before you commence your first treatment to make sure you do not have an infection in your bladder.
  • GM Urology will organise for your medication to be available from the Geelong Hospital Pharmacy on the day of your first treatment and then again on the day of your fourth treatment (you can only pick up 3 lots of the medication at a time).

WHAT DOES THE TREATMENT INVOLVE?

  • On the day of your treatment please limit your fluid intake for 4 hours beforehand. This reduces the amount of urine in your bladder, so the treatment is more effective.
  • You need to go to Geelong Hospital Pharmacy to collect your treatment. The pharmacy will give you 3 vials of the medication and you must bring this immediately to the rooms so they can be stored in our drug fridge.
  • When you arrive at the rooms the nurse will ask you to empty your bladder. Please tell the nurse if you have had any change in your urinary symptoms recently or after your first instillation e.g. pain, burning or blood in the urine.
  • The drug is slowly instilled into your bladder via the catheter.
  • The catheter is removed and you will be asked to hold the medication in your bladder for up to 2 hours, or as long as you can.
  • If you feel well and are able to hold the medication in your bladder you can go home. For your first treatment you will need to have someone to drive you home afterwards in case you have any adverse reaction to the treatment.

WHAT HAPPENS AFTER THE TREATMENT?

  • After two hours you need to empty your bladder. You should sit down to pass urine for the next 6 hours to prevent splashing (vaccine contains live virus), as the drug can cause a rash or skin irritation.
  • Once you have passed urine you need to put 1 cup of neat household bleach down the toilet and leave it for 15minutes before flushing. This needs to be done each time you pass urine for the next 6 hours. This makes sure you are not passing a live virus into the sewerage system.
  • Make sure you wash your hands well each time you pass urine. If any urine splashes onto your skin, wash it immediately with soap and water.
  • Once you have passed urine for the first time, you need to drink plenty of fluids for the next 6 hours to help flush the medication out of your bladder.
  • During the course of your treatment and for six weeks after your last does, you should use a condom when you have sex with your partner.

Six to eight weeks after completing the course of BCG, a further cystoscopy (look inside the bladder with a camera) will be organised to see how successful the treatment has been. Biopsies may be taken.

ARE THERE ANY SIDE EFFECTS?

  • You may notice some side effects after the treatment which may begin 2-4 hours after and can last for 1-2 days. Theses may include:
  • bladder spasms or cramps
  • burning or difficulty passing urine
  • blood in the urine
  • mild flu like symptoms
  • frequency or urgency passing urine
  • These side effects may not be evident until after your second or third treatment and may increase as your treatment course continues.
  • You can take Panadol to help with general symptoms, or Ural sachets for urinary symptoms.
  • You must contact GM Urology if you have any concerns with regard to your treatment or if any of the following symptoms occur:
  • Blood in the urine
  • Painful or frequent urination lasting for more than 2 days
  • Fever (greater than 38.5 degrees) and chills
  • Nausea and vomiting
  • Increased or new cough
  • Skin rash
  • Joint pain
If you experience any of these or have any queries please contact GM Urology on 03 5201 7000 during business hours OR leave a message on the After Hours Urology Paging Service 03 9387 1000