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A. With intravesical therapy for bladder cancer, drugs are put directly into the bladder through a catheter, instead of being injected into a vein or swallowed. Both immunotherapy and chemotherapy drugs can be given this way.
A. If a superficial tumour can be fully and safely resected during TURBT without an indication of deep invasive growth, an immediate instillation can be given after the procedure. A single instillation is not given if you have multiple tumours, if removal required surgery deep in the bladder wall, if there was possible perforation of the bladder, or if post-operative bleeding is too severe.
An immediate single instillation destroys tumour cells floating in fluids after TURBT and kills residual tumour cells at the site of removal and on small overlooked tumours.
This reduces the risk of recurrence. It is recommended to give the instillation as early as possible, usually within the few hours after TURBT.
A. Additional intravesical chemotherapy after surgery depends on the prognosis.
If you have low risk of recurrence and progression, a single instillation after TURBT is sufficient to reduce the risk of recurrence and is considered to be the standard treatment.
If you have intermediate-risk tumour, a single instillation may not be enough, so additional chemotherapy instillations may be necessary. The optimal number and frequency of chemotherapy instillations have not been determined.
A. Bacillus Calmette-Guérin (BCG) is a weakened (attenuated) bacterium related to the germ that causes tuberculosis. For this reason, it is very important that you report to us any history of prior tuberculosis, even if it was only suspected. Other immunotherapies that you might have received in the past should also be reported.
BCG activates the immune system by causing superficial inflammation in the bladder that attracts and stimulates immune cells to kill cancer cells. Treatment usually starts a few weeks after TURBT and is given once a week for 6 weeks.
Long-term ‘maintenance’ BCG therapy is sometimes given by extending the therapy to 12-36 months. Studies have shown that BCG therapy reduces the risk of progression for all different types of non-muscle invasive tumours.
As an outpatient treatment, the irrigation is given through an intermittent catheter. You should hold the irrigation fluid, ideally, for 2 hours before emptying the bladder.
Several protocols have been tested and proven effective, but patient reactions to this therapy vary. Consequently, the optimal number of induction instillations and the optimal frequency and duration of maintenance instillations have not been determined.
A. Some common side-effects include fatigue, nausea, diarrhoea, high blood pressure, and taste alterations.
Intravesical chemotherapy: The main side-effects of intravesical chemotherapy are irritation and a burning feeling in the bladder, which will disappear spontaneously after a few days.
BCG toxicity: Treatment with BCG is known to have more side-effects than intravesical chemotherapy. BCG can cause a burning feeling in the bladder and symptoms similar to the flu, such as fever, chills, and fatigue. Rarely, BCG is absorbed by the circulatory system and enters the rest of the body, leading to a serious infection (sepsis). In this case, you may experience high fever that does not get better with a pain reliever. You should contact the urologist right away if this occurs. Your doctor will prescribe antibiotics used to treat tuberculosis, and those must be taken for several weeks.
A. If you need treatment for cancer, you will experience unpleasant side-effects. Information on side-effects is included in the packet leaflet for the medicines used.
Side-effects can be common, very common, or uncommon, and management includes therapies to relieve them. It is important to tell your doctor about the side-effects you have.
Write down your symptoms every day and try to describe them as precisely as possible. Note how often they occur and how much they affect your daily life. In some cases, temporary treatment interruption, dose modification, or stopping the treatment can be considered.
Dealing with fatigue: You may experience fatigue, which means you may feel more tired than usual, be out of energy, and have trouble concentrating, and it does not get better after you sleep.
If you experience fatigue, some strategies can help:
Dealing with Nausea: During treatment, you may experience nausea caused by therapy, tumour growth, or anxiety about your prognosis. It may help if you:
Dealing with diarrhoea: Another common side-effect of the treatment is diarrhoea, which can lead to dehydration. It is important to:
You may also experience a mild to moderate rise in blood pressure, especially early in your treatment. This is normal and can be managed with standard therapy. If you feel dizzy or have a headache, let your doctor know as soon as possible.
Dealing with change in taste: Chemotherapy can also cause changes in how food tastes to you. You may even begin to dislike certain foods you liked before. The best way to figure out what food you like is to try different things: