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BCG INSTILLATION

BCG (Bacillus Calmette-Guérin) is a type of immunotherapy used in the treatment of bladder cancer. BCG is administered directly into the bladder via a catheter. 

ABOUT BCG

Bacillius Calmette-guerin is similar to the bacteria that causes tuberculosis.  It is a live modified version of the bacteria, therefore special precautions are required before, during and after the treatment.

WHY IS BCG REQUIRED?

BCG attaches to the bladder wall and stimulates an immune response to destroy the cancer cells.  It is used to treat superficial bladder cancer and to reduce the incidence of the cancer from returning.

In order to stimulate an inflammatory response the bacteria must be in direct with the bladder.  This requires the medication to be placed within the bladder using a catheter.

WHAT DOES BCG INVOLVE?

The initial course is a once a week treatment for six (6) weeks.

Your doctor may also arrange for a maintenance programme which is a shorter course on a regular basis.

We can perform the treatment either in our rooms or in hospital, as a day procedure.

Please inform your doctor if you are on the following medicines or treatments;

  • Antibiotics
  • Diuretics
  • Treatment for tuberculosis
  • Any immune suppressants
  • Radiation therapies
  • Bone marrow suppressants

Also inform your doctor if you have:

  • Blood in your urine
  • Incontinence
  • Tuberculosis
  • HIV

BCG is not advised for pregnant or lactating women.

A week before:

A urine test is required prior to the treatment to ensure that you do not have an infection.

If an infection is present it will be treated with antibiotics and the treatment course delayed for a short period.

Prior to treatment:

  • Do not drink anything for four (4) hours prior to your treatment. This limits the amount of urine produced during the treatment.
  • You may eat.
  • If you need to take medication this can be done with a mouthful of water.

During the treatment:

  • Do not drink during the treatment
  • A catheter will be inserted into the urethra to access the bladder. This is used to put the BCG into the bladder.
  • You will need to keep the medication in your bladder for 2 hours. Do not go to the toilet during this time.   If you are concerned about not being able to hold on for the duration of the treatment, speak to the nurse prior. In this case, the catheter may be left in place to help you retain the medication.
  • We require you to change position every 15 minutes

 After the treatment and for the following 6 hours:

  • Sit on the toilet to empty your bladder. This reduces splashing of urine. Do not flush the toilet.
  • Add two (2) cups of household bleach into the toilet
  • Close the lid
  • Wash and dry your hands
  • Let it stand for 15 minutes before flushing
  • If you have more that one toilet in the house, consider making one toilet your personal use for that day.

Sex

It is advisable to refrain from intercourse for the week after each treatment. The use of a condom may protect your partner provided it is used correctly and does not break.

Women should use additional birth control to prevent becoming pregnant during the treatment.

 Follow up

We need to check your bladder after the completion of your treatment course.

Please contact us a month after completion, if you have not received an appointment for a check cystoscopy.

WHAT IS THE RECOVERY AFTER BCG?

This is a day procedure and your can return to work when you wish.

The treatment needs to be held in your bladder for two hours but the whole process will take longer. Please expect to be at the hospital for most of the day.

You may drive to and from your appointments.

WHAT ARE THE RISKS OF BCG?

Common risks (1/2 – 1/10)

  • Infection in your urine. This usually means your next dose will need to be postponed.
  • Some bladder discomfort and discomfort when urinating
  • Flu-like symptoms which can last for two to three days
  • Urgently wanting to pass urine and needing to pass it more frequently (lasting up to 3 days)
  • Blood in your urine

Occasional risks (1/10 – 1/50)

  • Narrowing of the urethra following repeated catheterisation
  • Inflammation which can affect various parts of the body.

Rare risks (1/50 – 1/250)

  • Persistent or severe pain after treatment
  • Generalised (and serious) infection with BCG bacteria needing treatment in hospital with strong antibiotics.

Please notify your doctor or seek urgent medical attention if you have a:

  • Allergic reaction -shortness of breath, rash/hives, and/or swelling of the face or mouth
  • Signs of BCG infection – joint pain, chills and high fever (>39.5C) longer than 12 hours or moderate fever (>38.5C) longer than 2 days.
WHERE CAN I FIND MORE INFORMATION ABOUT BCG?

https://www.bladdercancer.org.au/

British Association of Urological Surgeons (BAUS): Instillation of BCG into the bladder for immunotherapy. https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/BCG.pdf

REFERENCES

Lawrentschuk, N (ed). (2017). Bladder Cancer.org.au Solving the puzzle. Leap Marketing Solutions. Australia.

Merck Sharp & Dohme. (2016). A guide for patient starting OncoTICE® treatment. [Brochure]. Macquarie Park: MSD.

OncoTICE. (2019). In MIMS Monograph.

The British Association of Urological Surgeons BAUS. (2017). Instillation of BCG into the bladder for immunotherapy. Retrieved from https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/BCG.pdf