BCG for Bladder Cancer (Effectiveness and Side Effects)

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Treatment options for bladder cancer are closely associated with the stages and grades of the disease. There are some options of the treatment to treat this kind of cancer, and one of them is BCG – it stands for Bacillus Calmette-Guerin. Is it effective to cure the disease? When the specialists need to use it? And what are the side effects of this treatment?

You might also like to know more about best foods to reduce your risk of developing cancer, before continuing!

In general, BCG is one of common choices to treat early bladder cancer. And according to an article published on WebMD, it is also often prescribed by doctors to reduce the risk of the recurrence (return) of noninvasive bladder cancer (noninvasive means the cancer cells have not spread into the muscle layer or haven’t spread beyond the inner lining of bladder), particularly after TUR surgery (Transurethral Resection surgery). TUR is one of kinds of surgery to remove cancer in the bladder.

The following are more FAQs about BCG!

What is the correlation between stages and grades of the disease with BCG?

As mentioned before, once again the treatment options for this kind of cancer are closely dependent on the stages and grades of cancer. For BCG itself, it is commonly used for grade 3, or sometimes for grade 2 of bladder cancer – according to an article published on the Cancer Research UK.

In general, there are three major grades of bladder cancer, these include:

1. Grade 1 (low grade) which means the cancer cells are very like the normal cells in the bladder. In this grade, the cancer cells are more likely to not spread and also grow slowly.
2. Grade 2 (moderately differentiated /medium grade) which means the cells of cancer look more abnormal than grade 1. In essence, in this grade the cancer cells can grow more quickly than in grade 1. Furthermore, there is also a chance for the cancer cells to spread.
3. Grade 3 (poorly differentiated /high grade)! Cancer cells in the bladder that are categorized into grade 3 are very like abnormal that can grow more quickly than grade 1 and 2, and they also tend to spread.

And for the stage, BCG is usually used when the cancer cells are still completely in the innermost bladder’s layer – this is very early stage or also familiar called as ‘CIS stage’.

Will BCG be effective enough to treat bladder cancer? And how does it work?

For noninvasive bladder cancer, experts believe that the use of BCG will be effective enough to greatly decrease the risk of cancer cells to progress after TUR surgery.

Unfortunately, there is still no clearly answer how it works. In treating bladder cancer, it may cause inflammation or stimulate an immune response of the wall of bladder which then will destroy the cells of cancer within the bladder.

In other words, the working principle of BCG may be similar with a kind of immunotherapy. It may stimulate cells of autoimmune system to become more active, which then they probably destroy and kill the cells of cancer that might have been left behind or grow back in the lining of bladder.

It is usually given with intravesical therapy. In treating bladder cancer, the liquid BCG is used and directly putted into the bladder of patient through a tube /device called ‘catheter’ – and then doctor /specialist will remove the catheter after directly putting the medicine into the bladder.

Then patient should not urinate for the next 2 hours after the treatment, otherwise the effectiveness of BCG may decrease. This is suggested in order to give adequate time for BCG to be in contact with bladder lining.

Furthermore, patient also should be careful when urinating for 6 hours after the treatment. Below are more pieces of helpful information:

1. Before taking this treatment, patients are usually asked to limit their fluid intake for about four hours before performing the procedure so they will be able to avoid urinating for about 2 hours or more after the treatment which then will be useful to hold the liquid medicine /drug in their bladder during treatment.
2. After about 2 hour, doctors usually ask /allow their patients to urinate. Doctors also ask the patient to change the position for each 15-20 minutes in order to make the medicine get a completely contact with the entire wall of bladder.
3. To eliminate the risk of skin irritation, patients should clearly wash their genital area after every time they pass urine - particularly during 6 hours after the treatment.
4. The treatment is generally prescribed once a week for six weeks. But sometimes after this, doctors may still give BCG once a month for 6-12 months. Or even some patients still get it continuously every 3-6 months for the next two years. These decisions are dependent on each circumstance of each patient. 

In addition, BCG is also a familiar vaccine for TB (tuberculosis), therefore it is also pretty common to be used in countries where tuberculosis is common in order to provide more protection against TB (tuberculosis).

Are there any side effects from the use of BCG?

Almost all treatments for cancer can cause some side effects, including BCG. Some mild side effects of this treatment may include:

1. Loss of appetite.
2. Nausea and vomiting.
3. Having fever (about 38 degree Celsius /101 degree Fahrenheit or less).
4. Skin rash, joint aches, or easily to get fatigue.
5. Patient is also more likely to have small amounts of urination but more often (frequent urination problem).
6. Pain /burning with urination.

Below are some statistics from the Cancer Research UK about side effects of BCG:

1. About 1-2 out of 100 patients experience painful joints.
2. About 1 in 2 patients experience flu, particularly for 1-2 days after the treatment.
3. About 7 out of 10 patients have frequent urination problem.
4. Even blood with urination and irritated bladder may also occur. For irritated bladder, it occurs in about 2 out of 3 patients. And about 1 in 4 patients who experience blood in their urine.

Furthermore, there is a chance for some of the TB (tuberculosis) to also get into the system of body’s patient when taking BCG treatment option – though this chance is very small. But if this does occur, patient may experience one or some of the following symptoms:

1. Experiencing extremely tired.
2. Vomiting /feeling sick.
3. Skin rash.
4. Cough, chills, or fever.
5. And joint pain.

Other more severe side effects that may occur include: (a) disseminated tuberculosis /allergic reaction to BCG, (b) pneumonitis or inflammation in tissue of lung, (c) obstruction in the ureters or contraction in the bladder, (d) abscess /hepatitis, and (e) infection /inflammation of the testicles, epididymis, & prostate in male patients.
*** If you experience these symptoms /side effects after taking a BCG treatment, contact your specialist or doctor promptly to get more advice!
Option of bladder removal - and shortage of BCG
Unfortunately there is still a worldwide shortage in supply of BCG vaccine. Therefore, sometimes specialists cannot choose to use this treatment for their patients with early bladder cancer or to reduce the risk of the removed cancer to reoccur after surgery.
If cancer of a patient with early bladder cancer has been removed, and at the same time BCG is not the option but the specialists are concerned about the chance of cancer coming back – then bladder removal option may be suggested. 
But the choice of removing bladder is also dependent on the condition of patient. Doctors usually only choose it if patient is fit enough to perform a surgery, otherwise they will consider other treatments such as chemotherapy into bladder -- ask a doctor /specialist for more detailed information!________Reference: Articles published on the Cancer Research UK and WebMD