BCG Treatment: What you need to know about this treatment for bladder cancer (BCG Treatment)

Has your doctor told you that you have bladder cancer and that you need to have BCG treatment? It's normal to feel a little scared and nervous when you hear that. "What kind of medicine is this?", "Will this make you feel sick?", etc. Many questions probably come to mind. But this is a widely used treatment that has been shown to be successful in many people with early-stage bladder cancer. So today, let's talk briefly about what BCG treatment is, how it is done, and what you need to know.

What exactly is BCG treatment?

Simply put, BCG (Bacillus Calmette-Guerin) is a treatment that is given inside your bladder. This is medically called intravesical immunotherapy . It is a liquid medicine. You may have heard of the tuberculosis (TB) vaccine. The BCG medicine is made by weakening the bacteria `(Mycobacterium bovis)`, which is the same type of bacteria used to make that vaccine. It may sound a little scary when you say "putting bacteria into your body", but what it does is weaken the bacteria in a way that doesn't harm your body and stimulates your own immune system to fight cancer cells.

This treatment often begins after the bladder cancer has been surgically removed. This surgery is called TURBT (transurethral resection of bladder tumor) . After that, BCG treatment is given to destroy any remaining cancer cells.

What types of diseases is this BCG treatment given for?

BCG therapy is mainly used to treat early-stage bladder cancer . This means that the cancer has not spread to the muscle layer of the bladder. For example, it is very effective for conditions such as `(carcinoma in situ)` (cancer that remains where it started) and `(non-muscle invasive bladder cancers - NMIBCs)`.

Clinical trials are currently underway to see if BCG can be used to treat conditions such as fibromyalgia and diabetes, but no definitive conclusions have been reached yet.

Is BCG a type of chemotherapy?

No. This is where many people get confused. BCG is not chemotherapy. Chemotherapy involves giving powerful drugs that directly kill cancer cells. BCG is an immunotherapy . This means that this drug does not kill cancer cells directly. Instead, it "tricks" your body's own immune system into recognizing and attacking cancer cells. It's like showing your own army the enemy and helping them fight.

How to prepare before BCG treatment?

Your doctor will clearly explain what you need to do before treatment. Generally, you should follow these instructions:

• Avoid drinking caffeinated beverages, such as coffee and tea, for four hours before treatment.
• Also, if you are taking diuretics/water pills, talk to your doctor about it and avoid taking them four hours before your treatment.
• After arriving at the hospital, you should urinate thoroughly and empty your bladder before starting treatment.

These things are done so that the BCG medicine administered stays well in the bladder and provides maximum results.

What happens during treatment?

Before the treatment begins, the area will be numbed to make sure you don't feel any discomfort. Then, the doctor or nurse will insert a thin tube (catheter) through your urethra into your bladder. This may feel a little uncomfortable, but it won't hurt much. The BCG solution will be injected into your bladder through the tube. Once the medicine has been completely injected, the tube will be removed. You can then go home.

However, even after you go home, you should try not to urinate for at least another hour . In total, it is recommended to keep the medicine in your bladder for two hours . During these two hours, you may be asked to change your body position (turn around) every 15 minutes. This is to ensure that the medicine reaches all parts of your bladder. After the two hours are up, you can urinate normally.

Can this treatment be transmitted to others? What precautions should be taken?

Yes, this is very important. The BCG vaccine contains live, but weakened, bacteria. Therefore, these bacteria can be transmitted from you to someone else. To prevent this, you must follow these steps for the first six hours after each treatment :

• Don't use public toilets. Use your own toilet at home as much as possible.
• Drink plenty of water and fluids. This will dilute your urine and reduce the concentration of bacteria.
• Sit down when you urinate. This will reduce the amount of urine that spills out.
• Most importantly: After urinating, pour 2 cups of undiluted bleach into the toilet bowl, close the lid, leave it for about 15-20 minutes , and then flush. This will kill any bacteria that may be in the toilet.
• If you have urinary incontinence and your bed clothes are soiled with urine, wash them separately in the washing machine. Do not put them together with other people's clothes.
• If you use an incontinence pad, soak it in a little bleach before removing it, place it in a plastic bag, tie it tightly, and throw it in the trash.
• If you have sex during treatment, you should definitely use a condom . Ask your doctor for more information about this.

Are there any side effects of BCG treatment?

As with any treatment, BCG treatment can cause some side effects. However, these are usually not serious and subside within two to three days.

Your doctor will prescribe medication to manage these common side effects. You can take a common painkiller, such as paracetamol, for fever and pain.

What time should I call the doctor?

• High fever (over 38.5°C or 101.3°F)
• If you are shivering with cold
• If the bladder is painful (Bladder spasms)
• Severe nausea or vomiting

Symptoms like these may indicate a condition such as an infection, so it is essential to seek medical advice.

Is it possible for cancer to come back after BCG treatment?

This is also a very important question. As with any cancer treatment, there is a risk of cancer coming back after BCG. According to statistics, up to 40% of people who receive BCG treatment may have their cancer come back.

But here's something important to understand. Even if cancer comes back, it doesn't always get worse or spread. Low-grade cancers in the early stages usually don't spread to other parts of the body.

Rarely, aggressive cancer can develop after BCG treatment. If this happens, your doctor may recommend a cystectomy, which involves removing the entire bladder. This is why it is important to have regular check-ups after treatment.