Has your doctor told you or someone in your family has bladder cancer? Then you may have heard of a treatment called BCG. Many people are a little scared when they hear this name, because it is not like a regular medicine. But there is no reason to be afraid. So today we will talk about what this BCG treatment is, how it is done, and everything you need to know about it in a very simple and friendly way.
What exactly is BCG treatment?
Simply put, BCG is a solution containing a weakened form of a bacterium called Bacillus Calmette-Guerin . You've probably heard this name before, because it's the same bacteria that's used in the vaccine to prevent tuberculosis. But don't worry, this treatment won't cause you to get tuberculosis.
What happens in this case is that this bacterial solution is injected directly into your bladder. Then, your body's own immune system is immediately activated. That is, it stimulates your own body's defenses to fight (against cancer cells). This stimulated immune system finds the cancer cells in the walls of the bladder and attacks and destroys them. This is not a direct cancer cell-killing `chemotherapy` drug, but rather a method of controlling cancer by using the body's own fighting ability.
In Sri Lanka, this treatment can be found under brand names such as `Theracys` or `TICE BCG`.
Things you need to tell your doctor before starting treatment
This treatment is not for everyone. Therefore, it is very important to talk openly with your doctor about your health condition. If you have any of the following conditions, be sure to tell them before starting treatment.
- If the wall of a blood vessel becomes weak and bulges like a balloon (an `aneurysm`).
- If you have blood in your urine.
- If you have had a bladder biopsy within the past two weeks.
- If you currently have a fever or other infection.
- If you have immune system problems.
- If you have other cancers such as leukemia or lymphoma.
- If you have neurological diseases such as `myasthenia gravis`.
- If you are about to have or have had an organ transplant.
- If you have artificial implants in your body (e.g. artificial joints, prosthetic heart valves, arterial grafts).
- If you have recently had or are undergoing radiation therapy.
- If you currently have tuberculosis or have had it in the past.
- If you have an allergic reaction to BCG, latex, or any other medicine or food.
- If you are pregnant, trying to get pregnant, or breastfeeding, this is very important.
How BCG treatment is given and what to do afterwards
You will not be given this medicine to take home. It is given in a hospital or clinic by specially trained healthcare staff.
First, a thin tube (catheter) is inserted into your bladder, through which the BCG solution is injected. This may feel a little uncomfortable, but it is not very painful. After the injection, the tube is removed. You will then be instructed to keep the injection in your bladder for 1 to 2 hours . You should try not to urinate during this time. You may be asked to lie down or roll from side to side so that the injection reaches all parts of your bladder.
The most important thing is what to do after treatment. Since this medicine contains live bacteria, you need to prevent them from being transmitted to others through your urine. That's why you need to follow the instructions below.
Be sure to do the following every time you urinate for the first 6 hours after treatment.
| What to do | Why and how to do it? |
|---|---|
| Sit down and urinate. | Even if you are a man, please sit on the toilet and urinate. This will help prevent urine from spilling out. Avoid using public toilets or urinating outdoors. |
| Pour bleach into the toilet. | After you're done urinating, pour 2 cups of undiluted bleach into the toilet bowl. Close the toilet lid, leave it for about 15-20 minutes , and then flush. This will kill any bacteria in the urine. |
| Wash hands and genital area. | After using the toilet, wash your hands and the area around your genitals thoroughly with soap. |
| Drink more water. | After urinating for the first time, drink plenty of water and fluids throughout the day. This will dilute your urine and reduce inflammation in your bladder. |
| If you cannot control your urination | If you have incontinence and it gets on your clothes, wash them separately in the washing machine immediately. Do not put them with other clothes. If you use an incontinence pad, soak it in a little bleach before throwing it away, put it in a plastic bag, seal it, and put it in the trash. |
Other important things you should know
What if I miss a dose of medication?
This treatment usually lasts for several weeks, so it is very important to go to the hospital on the scheduled date. If you are unable to go on the scheduled date, call your doctor or clinic immediately and let them know.
Can there be interactions with other medications?
Yes. Some medications can interfere with the effectiveness of this treatment. In particular:
- Antibiotics
- Immunosuppressant drugs (e.g. corticosteroids, other cancer medications)
- Medicines for tuberculosis
Therefore, tell your doctor about all the medications you take (including vitamins and herbal products), and if you smoke or drink alcohol.
Things to consider during treatment
You may feel feverish and have aches and pains for a day or two after treatment. This is normal. However, if these symptoms last more than two days, get worse, or if you have any unusual or severe symptoms, call your doctor right away.
Do not become pregnant while taking this medicine. This medicine can cause serious harm to an unborn baby. Also, avoid breastfeeding. If you have sex, always use a condom . Ask your doctor for advice on how long to do this.
Be aware of side effects
As with any medical treatment, BCG treatment can cause side effects. Some of these are common, while others can be serious.
| Types of side effects | |
|---|---|
| Serious side effects that you should report to your doctor immediately | |
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| Side effects that are usually not serious, but should be reported to the doctor if they persist | |
| |
What if I take too much medicine?
Since this treatment is given in a hospital, there is no way you could overdose. However, if you develop severe symptoms after treatment, immediately call the National Poisons Information Centre at the Colombo National Hospital , or go to the Emergency Treatment Unit (ETU) of the nearest hospital.
Take-Home Message
- BCG is a treatment that stimulates your body's own immune system to fight bladder cancer.
- This treatment is given in the hospital, through a tube (catheter) inserted into the bladder.
- For the first 6 hours after treatment, be sure to follow special hygiene measures, such as flushing the toilet with bleach, to protect others.
- Before starting treatment, tell your doctor about all your medical conditions and medications you are taking.
- Seek immediate medical attention if you experience severe side effects such as high fever, difficulty breathing, or blood in your urine.
- Avoid pregnancy during treatment and use a condom during sex.
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