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What is Intravesical Therapy or Treatment?

Treatment into the bladder is called intravesical treatment. Intravesical therapy for bladder cancer means putting liquid drugs directly into the bladder through a tube called a catheter. The aim of this treatment is to treat the cancer and stop it from coming back or spreading into the deeper layers of the bladder. You can have intravesical treatment with BCG vaccine or with chemotherapy drugs.

How is the intravesical therapy given?

First you need to have a urinary catheter (tube) put into your bladder. The doctor or nurse puts the BCG or chemotherapy drug into your bladder through the catheter. The catheter may then be taken out. You have to try not to pass any urine for the next two hours. This gives the drug sufficient time to be in contact with the lining of the bladder. You then pass urine naturally to get rid of the drug. Or your nurse drains the drug out through a catheter. For some people with early bladder cancer, this is all the treatment they need.

What is BCG and how does it work?

BCG is a vaccine for tuberculosis (TB). It has also been found to be effective in stopping bladder cancers from growing back or spreading into the deeper layers of the bladder. It seems to encourage cells of the immune system to grow and become active in the lining of the bladder thus it works as a type of immunotherapy. These cells of the immune system probably kill off any cancer cells that might grow back or have been left behind in the bladder lining.

What is the treatment schedule for Intravesical BCG therapy?

You are likely to receive a 6-week Induction course followed by 3 weekly instillations at 3 and 6 months and every 6 months thereafter for 3 years.

Your doctor will perform and endoscopic examination (cystoscopy) of the bladder and a urinary cytologic study every 3 months during the treatment.

What precautions do I have to take after the Intravesical BCG therapy?

The BCG is a liquid and your doctor or nurse put it into your bladder through a tube (catheter). The catheter may then be taken out. You should try not to pass urine for 2 hours. When you do pass urine, you have to be careful for 6 hours after the treatment because the vaccine contains live TB. Men should sit down to pass urine, to reduce the chance of splashing. You should try not to get any urine on your hands. After you've been to the loo, pour about half a pint of neat bleach into the toilet bowl and leave it for 15 minutes before flushing. This makes sure you are not flushing live TB into the sewer system. Then, as always, wash your hands!

What are the potential side effects of BCG?

You probably won't have too many side effects from this treatment although you may experience one of the followings.

  • About 2 out of 3 people have an irritated bladder - this feels a bit like having a urine infection
  • About 7 out of 10 people want to pass urine more often than usual
  • About 1 in 4 people have blood in their urine
  • About 1 in 2 people have flu-like symptoms for 24 to 48 hours after each treatment
  • About 1 or 2 out of 100 people have painful joints

If you have any of these symptoms, tell your doctor at your next appointment.

You can take Tab Paracetamol (Crocin) 650-1000mg for mild symptoms.

There is also a very small chance that some of the TB could get into your system and give you TB symptoms such as
  • Fever and chills
  • Joint pain
  • Feeling sick or vomiting
  • Cough
  • Skin rash
  • Feeling extremely tired

This only happens to less than 1 person in every 100 who has this treatment. It is important that you tell your doctor straight away if you have any of these symptoms. You may need treatment with anti TB drugs and should not wait until your next appointment to let your doctor know.

Chemotherapy into the bladder

For this type of treatment, you have a solution of a chemotherapy drug (mitomycin, epirubicin or doxorubicin) put into your bladder weekly for 6 weeks. Like BCG, this helps to stop the tumours growing back.

The chemotherapy is a liquid given into the bladder through a flexible tube (catheter). For 6 hours after the treatment, you have to be careful when you pass urine. The urine contains some chemicals from the chemotherapy. Men should sit down to pass urine, to reduce the chance of splashing. You should try not to get any urine on your hands.

Chemotherapy side effects

Giving chemotherapy into the bladder does not have as many side effects as having chemotherapy tablets or injections. The drug tends to stay in your bladder and very little of it gets into the bloodstream.

The main side effect is irritation of the bladder. You may feel as if you have a bad urine infection (cystitis). If you have this side effect you will feel that you want to pass urine very often and it may be uncomfortable when you do pass urine. About 1 out of 10 people (10%) develop a rash on their hands or feet for a short time after having the treatment.

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