Patient's Query
Hello doctor,
I have just been diagnosed with non-invasive bladder cancer (CIS) and have just started BCG. I am a little confused, as I have had two different doctors tell me two different things. One doctor told me that I needed a chest CT scan because the cancer had spread, but the other doctor, on the contrary, said I did not need that, as NIMBC does not spread to the lungs. I have already had the uro-CT scan and MRI. I do not want to have more radiation or any other further incidental findings to worry about.
Can you give me your opinion?
Kindly help.
Hello,
Welcome to icliniq.com.
I read your query and can understand your concern.
NMIBC, or non-muscle-invasive bladder cancer, per se, does not have a propensity for lung metastasis (spread), but muscle-invasive cancer does. So, as long as your diagnosis has been confirmed to be NMIBC after a re-staged TURBT (transurethral resection of bladder tumor), given that it is a T1 tumor (primary tumor), you are okay to proceed without a CT (computer tomography).
I hope that they perform a second TURBT as well because, as you mentioned earlier, the pathology is CIS (carcinoma in situ), which is a high-grade lesion that has a propensity to become muscle-invasive. The only other reason you might be advised to get a chest CT would be if they picked up something abnormal on the preoperative chest X-ray or if you have a history of other lung conditions.
Your BCG (Bacillus Calmette-Guérin) is a live vaccine that is a weakened form of the bacterium Mycobacterium bovis that is used to prevent tuberculosis (TB) (an infectious disease that most often affects the lungs and is caused by a type of bacteria) and other mycobacterial infections. Therapy should continue for at least three years, and I would strongly suggest you are on regular follow-up to detect recurrences.
I hope this helps.
Kindly revert in case of queries.
Patient's Query
Hello doctor,
Thank you for the reply.
They did not do a second TURBT, but I had the original slides read by two pathologists, one of whom is at the hospital where I am being treated; they are very specialized. Both pathologists agreed the biopsies were not in the muscle or layer above. I then had a flexible cystoscopy before starting BCG. I also had a uroscan with both CT and MRI. Neither of the doctors suggested I need another TURBT. Is that usual for the CIS? Also, they did a P53 test, and it came back with no abnormal patterns, so my doctor says it is not clinically significant.
Why is that?
Kindly help.
Hello,
Welcome back to icliniq.com.
Guidelines recommend repeating a TURBT (transurethral resection of bladder tumor) for any high-grade bladder lesions. Hence, here is my recommendation. CIS (carcinoma in situ), even if it is NMIBC (non-muscle-invasive bladder cancer), still warrants a second TURBT for completion's sake and to avoid missing out on the 15 percent chance of a muscle-invasive tumor. However, this opinion may vary from surgeon to surgeon.
I hope this helps.
Thank you, and take care.
Patient's Query
Hi doctor,
I have one other question - There seems to be very mixed opinions on using lubricants and Lidocaine for catheterization during BCG installation, as a couple of papers say it reduces the effectiveness of the BCG by the gel clumping the bcg together and the acid in the Lidocaine damaging the BCG.
My NCI center, where I am having my BCG treatment, uses both lubricants (I have to wipe up after) and lidocaine. Interesting, my nurse forgot to use lidocaine for the first one, but it was fine. She used it for the second one (only had two), and if anything, she thought it was a little more uncomfortable.
What is your opinion on using these and the negative impact on BCG? If any of it does impact it and I do not have any more, would that one time I did use lidocaine have an overall negative impact on the six-week course?
Thank you so much.
Hello again,
Welcome back to icliniq.com
In my opinion there is not enough concrete evidence to be worried about this. There are only small-scale studies that have demonstrated lower efficacy of BCG when administered after lignocaine gel. The only way it MAY interfere with BCG is if an excessive amount was instilled into your urethra, like a full tube or two.
So the short answer is no, it will not affect the efficacy. Besides, if only a small amount is placed on the catheter rather than into your urethra, BCG will not come into contact with lignocaine. There are pre-lubricated catheters available that do not require any lignocaine prior to insertion; these catheters are something you can use if you are worried about it.
So to summarize, no, the one time you had gel inserted prior to BCG will not have a negative impact. Hope this helps. Please let me know if there is anything else I can help you with.
Thank you.
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Answered byDr. Madhav Tiwari
Medically reviewed byiCliniq medical review team
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