BCG (Bacillus Calmette Guerin) is commonly used to treat superficial bladder cancer. This leaflet answers questions many people ask about the treatment.
What is BCG?
BCG is a live vaccine normally used to inoculate against TB. When it is put into the bladder it causes an inflammatory reaction to occur there. This inflammation seems to destroy the cancerous cells, although it is not yet clear exactly how it does this. However, BCG has been used very successfully world-wide to treat and prevent the recurrence of superficial bladder cancer.
Is there anything I need to do before treatment?
You should not drink too much fluid for 8 hours before the treatment. One glass of water may be taken with breakfast. If you drink as little as possible the kidneys will produce less urine and thus prevent the dilution of the BCG when it is in your bladder. It will also make it easier for you to retain the treatment in the bladder for the necessary amount of time. If you normally take water tablets (diuretics) take them after your BCG session rather than first thing in the morning for your treatment days.
Where do I come for the treatment?
You will be asked to come to the Urology Treatment Area which is located on Level 3. The initial course is once a week in the morning for 6 weeks. Some patients require further 3 week maintenance courses. You will be given an appointment time.
How long does the treatment take?
You will be in hospital for about 30 minutes to an hour. We try hard to keep to your appointment, but sometimes unavoidable delays do occur. You should feel well enough to drive yourself home after the treatment. However, if you are elderly or infirm, please arrange for a friend or relative to collect you.
Who gives the treatment?
The treatment is given by one of the Specialist Nurses: Jeanine Richards, Wayne Christie or Vicky Powell.
What will happen when I arrive?
You will be shown to a seat in the waiting area. When a bed becomes available you will be asked to provide a urine sample, empty your bladder and change into a gown.
How is the treatment given?
A catheter tube is passed into the bladder. The BCG, which is in 50mls (1½oz.) of fluid, is then passed via the catheter into the bladder. The catheter is then removed. You are asked not to pass urine for the next 2 hours. It is during this time that the treatment is working to destroy the cancerous cells or prevent them from recurring. You will be asked to lie on your front for 15 minutes before you get up and dressed. You can then go home but if you are worried you will not be able to hold the treatment until you get home you can sit in a chair but still try not to pass water for the two hours. Please bring something with you that will help pass the time, e.g. books, magazines, personal stereo etc.
What to do after each treatment
When the 2 hours are finished (or sooner if you are unable to hold on that long) use one of the toilets to pass urine (men should sit rather than stand to urinate). Do not flush the toilet but if you are at still at the hospital tell one of the nurses so that they can put strong disinfectant into the toilet, and a notice on the door asking other patients not to use it; this is because BCG is a live vaccine. You can then go home. Ask the staff for a drink and biscuits before you leave if you would like this.
For 6 hours after the treatment you need to do the following;
- Men need to sit rather than stand to urinate (to prevent splashing).
- After passing urine, pour 2 cups of undiluted liquid household bleach into the toilet and let it stand for 15 minutes before flushing.
- Drink 2.5 to 3 litres (5-6 pints) of fluids for the first 24 to 48 hours after the treatment to flush any remaining drug out of the bladder. This will also help prevent bladder irritability.
- If sexually active, engage in protective intercourse (i.e. with a condom), or abstain for the immediate post-treatment period (48 hours).
Are there any possible side effects?
Because the drug goes directly into the bladder, the common side effects are on the bladder itself. You will not lose your hair (this is a common worry). You may have increased frequency and urgency to pass urine. You may also experience a small amount of bleeding and discomfort when passing urine. Drinking plenty of fluids will help. If any of these symptoms persist for more than 24 hours, or you are passing offensive smelling urine you should contact your G.P. or he urology nurses because you may have a water infection.
Other less common side effects are;
- Fever and chills
- Skin rash
- Joint pain
- Nausea and vomiting
You can take Paracetamol or what you would normally take for a headache but again if any of these symptoms persist for more than 24 hours you should contact your G.P. or the urology nurses.
What drugs may interfere with the treatment?
Drugs and therapy that suppress your immune system, including radiation, can interfere with how well the malignant cells in the bladder respond to the treatment and may increase the risk of bone and other infections. That is why it is important to make sure the consultant or the specialist nurses are aware of all drugs you are taking before beginning your treatment.
If you think you have a urinary tract infection please consult the nurses before you start any antibiotics as this may prevent the treatment course continuing.
We hope these details are of help to you. If you have any worries or queries, do not hesitate to contact the Urology Nurses who are available 8am-4pm, Monday-Friday.
Telephone No: 01932 722387 or 01932 722770.
A separate leaflet is available to explain superficial bladder cancer. If you have not had one please ask.