نظرة عامة
BCG treatment is a type of immunotherapy used to treat certain non-muscle-invasive bladder cancers. Bacillus Calmette-Guerin (BCG) is a weakened form of bacteria that helps the immune system attack cancer cells in the bladder. BCG treatment is often given after a procedure that removes the tumor, called transurethral resection of bladder tumor (TURBT).
BCG is put directly into the bladder through a thin, flexible tube called a catheter. This is called intravesical therapy. BCG is immunotherapy, not chemotherapy. BCG goes directly into the bladder. Chemotherapy travels through the bloodstream to other parts of the body. BCG helps the immune system attack cancer cells left in the lining of the bladder. Because BCG contains weakened bacteria, it may not be safe for people with very weakened immune systems.
لماذا يتم ذلك؟
BCG most often is given after transurethral resection of bladder tumor (TURBT) to lower the risk that high-risk bladder cancer will come back. It also can lower the risk that the cancer will grow deeper into the bladder. BCG is commonly used when the cancer has not grown into the bladder muscle.
Whether BCG is right for you depends on your cancer risk, treatments you have already had and the results from earlier treatment. Your healthcare team may use tests to check your bladder and see how well treatment is working. These tests may include a cystoscopy, which uses a thin tube with a camera to look inside the bladder. Your care team also may order urine tests or do a biopsy.
المخاطر
The risks of BCG treatment come from its side effects. Most side effects are caused by irritation and inflammation in the bladder and usually start within hours after treatment.
Common side effects include:
- Burning or pain when you urinate.
- Needing to urinate more often or more urgently.
- Blood in the urine.
- Tiredness.
- Fever.
- Chills or other flu-like symptoms.
These side effects often last 24 to 72 hours.
Bladder irritation and side effects may become more noticeable after several BCG treatments. Your healthcare team may delay your next treatment or check for an infection if your symptoms are severe, last longer than expected or get worse.
Serious side effects are not common, but they can happen because BCG contains live, weakened bacteria.
Rare, serious side effects include:
- An infection that spreads outside the bladder.
- Inflammation in other parts of the body, such as the lungs, liver, prostate or joints.
Contact your healthcare team right away if:
You have a fever that does not go away, severe chills, worsening fatigue, severe urinary symptoms, cough or other symptoms that are becoming more intense or lasting longer than expected.
كيف تستعد؟
Tell your healthcare team about all medicines and supplements you take. Also, tell the team about any conditions or treatments that affect your immune system.
Your healthcare team may ask you to limit fluids for several hours before treatment, so you can hold the medicine in your bladder. Follow your care team's instructions about antibiotics and other medicines because some can interfere with live BCG.
It may be helpful to bring someone with you to your appointment. There can be a lot of information to remember. BCG treatment follows a specific schedule. You also need to follow instructions for safely handling your urine after treatment. Having someone with you can help you focus and remember the instructions.
ما يمكن أن تتوقعه
BCG treatment usually begins with a series of treatments. This is called the induction course. During induction, BCG treatment typically is given once a week for six weeks. If BCG treatment works, you may receive more BCG after the induction course. This is called maintenance BCG. The schedule and how long treatment continues depend on your cancer risk, side effects and treatment plan.
Before the procedure
Before treatment, your healthcare team checks for any new symptoms or urinary issues that could affect whether you may receive BCG.
BCG treatment may need to be postponed if you have:
- A urinary tract infection.
- A fever.
- Blood you can see in your urine.
- An injury caused by a recent catheter placement.
You empty your bladder before treatment.
During the procedure
During the procedure, your healthcare professional passes a thin, flexible tube called a catheter through the urethra into the bladder. BCG goes into the bladder through the catheter. The catheter is then removed.
You may be asked to change positions while the BCG is in your bladder. This helps the BCG reach different parts of the bladder lining. You are asked to keep the BCG in your bladder for about two hours. If you cannot wait that long, you may be allowed to empty your bladder sooner.
After the procedure
After you empty your bladder, your healthcare team members may ask you to drink extra fluids. For a short time after treatment, you may have mild burning when you urinate, a sudden need to urinate, a small amount of blood in your urine, tiredness or flu-like symptoms.
Safety precautions at home
BCG contains live, weakened bacteria. Because of this, you need to take special care with your urine for six hours after treatment.
During those six hours:
- Sit down to urinate. This helps prevent splashing.
- Add to the toilet bowl the same amount of undiluted household bleach as the amount of urine in the toilet bowl.
- Let the bleach and urine sit in the toilet for 15 minutes before flushing, unless your healthcare team gives you different instructions.
During the 6-hour precaution period
Follow your healthcare team's instructions for handling urine and cleaning the toilet during these six hours.
النتائج
There is no single success rate that applies to everyone who has BCG treatment. How well BCG works depends on:
- The type of bladder cancer.
- How high the risk is.
- Treatments you have already had.
- Whether you have had BCG before.
BCG is a standard treatment for some non-muscle-invasive bladder cancers. It does not guarantee that the cancer will go away or not come back after treatment.
Follow-up after BCG
After BCG treatment, you need regular follow-up visits. Tests done at these visits may include a test that uses a thin tube with a camera to look inside the bladder, called cystoscopy, and urine tests. These tests help check whether the cancer is still there, is gone or has come back. Bladder cancer can come back after treatment, so regular follow-up is an important part of care.
If bladder cancer returns after BCG
You may receive another six-week course of BCG if the cancer does not go away or comes back after the induction course.
Surgery to remove the bladder may be an option if the cancer comes back and is high grade. High-grade cancer means the cancer cells are more likely to grow or spread. Delaying surgery can allow the cancer to grow or spread.
If you cannot have surgery to remove the bladder or if you choose to have bladder-preserving treatment, your options may include:
- Chemotherapy treatments put into your bladder, such as gemcitabine and docetaxel.
- Immunotherapy medicines that travel throughout your body, such as pembrolizumab.
- Clinical trials, which are research studies that test potential new treatments or new ways of using existing treatments.
Newer treatment options
When BCG doesn’t work, or when cancer comes back after BCG treatment, it is called BCG-unresponsive bladder cancer. One type of BCG-unresponsive bladder cancer is carcinoma in situ (CIS). CIS is a flat cancer that grows in the bladder lining.
Newer treatments are available for some people with BCG-unresponsive CIS. These treatments can be used whether or not there are tumors that grow out from the bladder lining.
Nogapendekin alfa inbakicept is one newer treatment for BCG-unresponsive CIS. This medicine helps the immune system fight cancer. It is given with BCG.
A gemcitabine treatment for BCG-unresponsive CIS that is placed directly into the bladder may be another option for you.
Durvalumab used with BCG may be given to adults with high-risk non-muscle-invasive bladder cancer who have not had BCG before.
Your healthcare team can explain which newer treatments may be options for your cancer. The care team also can discuss whether a clinical trial may be an option.
التجارب السريرية
استكشِف دراسات مايو كلينك حول الاختبارات والإجراءات المخصصة للوقاية من الحالات الصحية واكتشافها وعلاجها وإدارتها.