Bacillus Calmette-Guérin Immunotherapy for Bladder Cancer

What Is a BCG Immunotherapy or BCG Treatment?

BCG or Bacillus Calmette-Guérin Immunotherapy is a treatment in which the doctor delivers the immunotherapy drugs directly to the patient’s urinary bladder through a catheter. It is intravesical immunotherapy because the drugs are directly injected into the urinary bladder. BCG treatment differs from other oral and injectable medications because it specifically targets the cancer cells in the bladder lining and does not have any adverse reactions on the other body cells. The drug is a liquid derived from the strain of Mycobacterium bovis; the bacteria used to develop the tuberculosis vaccine. When this bacteria is used in the drug, it is attenuated or weakened so that it does not harm the body. BCG treatment is usually done after the transurethral resection of a bladder tumor (a surgery done to remove cancer).

What Is Bladder Cancer?

Cancer is a condition in which the cells in the human body show uncontrolled growth. Usually, there are genes present in the body that control cell division and proliferation. However, when these genes fail to regulate cell growth and are predominated by defective genes, the condition is known as cancer. It can occur in any organ of the body. When cancer originates from the bladder's inner lining, the condition is known as bladder cancer. The urinary bladder is a balloon-shaped structure that stores urine temporarily. It consists of muscles that contract and relax to facilitate urine drainage.

What Conditions Can Be Managed With BCG Treatment?

BCG immunotherapy is mainly used to treat early-stage bladder cancer. Early-stage bladder cancer is when the cancer cells remain confined to the bladder and do not invade the bladder wall muscle. Early-stage bladder cancer is non-invasive muscle bladder cancer and carcinoma in situ. The limitation of BCG treatment is that it is ineffective against bladder cancer that has metastasized or spread to other body parts. Some clinical trials are being done to test the effectiveness of BCG treatment for fibromyalgia and diabetes. Some experts believe that BCG treatment could help eliminate these diseases because they stimulate the production of cytokines. BCG treatment should not be confused with intravesical chemotherapy and immunotherapy because different drugs are administered in both treatments. Cancer drugs or chemotherapeutic agents directly attack cancer cells, whereas immunotherapy drugs increase the power and capabilities of the immune system.

How Should the Patient Prepare for the BCG Treatment?

BCG treatment has become one of the most common treatments for intravesical cancer, and before the test, the doctor will give specific guidelines to the patient. The patient must not drink caffeine-containing beverages or have Diuretics (water pills) four hours before the procedure. Ensure the patient passes urine before the procedure because the urine might interfere with the drug.

What Happens During the BCG Immunotherapy?

• The doctor will administer local anesthesia before the treatment to make the patient comfortable so that the procedure can be carried out quickly.

• Next, the doctor inserts a tube known as a catheter into the urethra and injects the BCG liquid through the catheter.

• The primary aim of this procedure is that the BCG solution should come in contact with the cancer cells to kill them. Therefore, after the solution is injected, the doctor will remove the catheter and ask the patient to lie on his back, stomach, and sides for 15 minutes.

• When the procedure is complete, the patient can return home the same day but should not pass urine for at least one hour.

• Hold the BCG solution in the urinary bladder for two hours and urinate only after this time. Once the solution enters the bladder, the immune system gets activated and attacks the cancer cells.

• The initial BCG treatment is done for six weeks, and this stage is known as induction therapy.

• If the doctor finds the treatment effective and working, he might prescribe maintenance therapy. It is given once a week for three weeks in the third, sixth, and 12th months.

• Some people might undergo the treatment for three years.

Is BCG Immunotherapy Contagious?

The drugs used in BCG immunotherapy contain live tuberculosis bacteria that might transmit to others. However, the patient can follow the below-mentioned instructions for six hours after every BCG treatment:

• Do not use public toilets.

• Drink plenty of water to dilute the urine.

• Sit down on the toilet while urinating to avoid splashing.

• After passing urine, the patient must add two cups of undiluted bleach to the toilet and wait for 15 to 20 minutes before flushing.

• People with urinary incontinence or urine leakage must wash their clothes separately.

• If the patient wears an incontinence pad, soak the pad in bleach before discarding it in the trash.

What Are the Advantages of BCG Treatment?

The patient must not engage in sexual activities for a few days after the BCG treatment. Use a condom before having sexual intercourse until the BCG treatment is done. Then, the patient can consult the doctor to learn about the guidelines for sexual intercourse. BCG treatment has proven to be most effective when combined with transurethral resection of bladder tumors for early-stage bladder cancer. It helps slow tumor growth and reduces the chances of cystectomy or bladder removal surgery.

What Are Some of the Side Effects of BCG Treatment?

Side effects are commonly seen in the first 24 hours of BCG treatment. The side effects of BCG treatment are listed below:

1. Blood in the urine.

2. Low-grade fever.

3. Burning sensation while passing urine.

4. Fatigue or tiredness.

5. Urinating frequently or more than eight times a day.

6. Muscle pain.

7. Pain in the joints.

The doctor will provide medication to overcome these side effects or might ask the patient to take some over-the-counter drugs to reduce fever and discomfort. Mostly the side effects of BCG treatment subside within 72 hours, but the patient must consult the doctor if they persist. The less common side effects of BCG treatment are listed below:

• Skin rash.

• High-grade fever.

• Vomiting and nausea.

• Loss of bladder control.

• Bladder spasm.

• Inability to pass urine.

• Urinary tract infections.

• Testicular inflammation.

• Ureteral obstruction.

• Thickening and scarring of the bladder muscles.

• Cell death or necrosis.

• BCG sepsis might occur if the BCG solution enters the bloodstream.

• Neutropenia (reduced white blood cell count).

• Hepatitis and BCG-induced hypersensitivity pneumonitis.

Can Bladder Cancer Recur After the BCG Treatment?

Bladder cancer can return after BCG immunotherapy, similar to other cancers. Studies have reported that cancer recurs in about 40 % of the people who receive BCG treatment. However, an important point to note here is that cancer might recur but does not progress or spread to the other organs. Early-stage cancer usually does not metastasize or infect other organs, but people having low-grade cancer might develop other cancers in their lifetime. As per the report, aggressive bladder cancer is less likely to occur after BCG treatment. If it happens, bladder removal surgery or cystectomy must be done.

Conclusion:

Bladder cancer is a common condition and can affect males and females of any age. Several treatment options are available for the treatment of bladder cancer, including cystectomy, transurethral resection of the bladder tumor, and chemotherapy. Among all these treatment options, BCG immunotherapy is becoming popular among doctors and patients because it is a conservative option to address early-stage bladder cancer. The procedure gets completed in 15 to 20 minutes, and the patient is saved from the surgical trauma. So, the patient need not lose hope and must consult doctor immediately for the BCG treatment.