Tag Archive | "BCG treatment"

High-grade Bladder Cancer Patients Not Receiving Recommended Care

In a recently published study in Cancer, researchers at UCLA’s Jonsson Comprehensive Cancer Center found that just one in 4,545 people with high-grade noninvasive bladder cancer was treated according to the comprehensive care guidelines set by the American Urological Association and the National Comprehensive Cancer Network.

The cells in a patient with high-grade cancer show greater abnormality than cells in a patient with a low-grade tumor.  Guidelines for high-grade cancer require an initial injection of chemotherapy drugs directly into the bladder to kill cancer cells and an intense follow-up surveillance schedule that involves using a scope to assess the bladder (cystoscopy) and urine testing (cytology) four times a year.  This chemotherapy shot should be followed by a six-week course of Bacillus Calmette-Guerin (BCG) treatment, which creates an inflammatory response, causing the body to attack the cancer.  Also recommended is imaging of the upper urinary tract with a CT scan, MRI scan, or renal ultrasound at diagnosis and every two years.

Researchers found that compliance with these guidelines had more to do with the doctors treating the patients than with the patients’ age, race, or economic status.  They concluded that the guidelines my not be reaching urologists at community hospitals, which is where the majority of patients receive treatment.

The authors’ suggestions for increasing compliance rates included modifying reimbursement rates and conducting more research to identify factors inhibiting comprehensive treatment.  Karim Chamie, M.D., a postdoctoral fellow in urologic oncology and health services and the lead author of the study, believes that meeting the recommended guidelines for high-grade bladder cancer patients will significantly reduce the mortality rate.

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BCG Treatment for Bladder Cancer

Bacillus Calmette-Guerin or BCG is used as a vaccine against tuberculosis.  In addition, it is also used as a treatment for bladder cancer.

BCG therapy is often used after the cancer has been removed through bladder surgery to prevent a recurrence. It is also used to treat the early stages of superficial bladder cancer that do not require surgery.

There are two separate theories as to how BCG is able to treat bladder cancer. The first is that the immune response that BCG is able to generate in the bladder also activates the immune system against cancer cells. The other theory is that the inflammation caused by a BCG infection is also toxic against cancer cells. Regardless, BCG has been shown to be an effective therapy against bladder cancer.

It is administered in the doctor’s office and delivered directly into the bladder through a urinary catheter. Patients are required to empty their bladder immediately before treatment and then to not urinate for at least 2 hours. During this 2 hour, the patient will need to change position every 15 minutes so that their entire bladder receives the solution.  The patient is instructed to lie on his back, stomach and each side for 15 minutes at a time.  The treatment is usually given weekly for 6 weeks.

Several hours after the treatment, patients should drink extra fluids to flush the bladder. To disinfect the toilet after the treatment, patients should dilute their urine with household bleach for 6 hours after the treatment.  In order to kill any live BCG bacteria, bleach should be added to the toilet after urinating and allowed to sit for 15 minutes before flushing.

Common side effects of BCG treatment include pain or a burning sensation when urinating, as well as increased frequency and urgency of urination. Patients may also feel fatigue, pain in their joints and mild fever/chills. Other side effects are nausea, diarrhea, stomach pain and loss of appetite. These symptoms are typical of a bladder infection and tend to be fairly mild and disappear after a few days.   BCG may also cause serious side effects like hepatitis, pneumonitis, allergic reaction, lowered white blood cell count, blood in urine, bladder contractions and abscess.

BCG therapy is used with caution in patients with weakened immune systems as well as those receiving treatments that compromise the immune system.

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