Standard Care Treatment for Non-Muscle Invasive Bladder Cancer

As per my last post, I was diagnosed with non-muscle invasive bladder cancer and after my TURBT and the pathology report, it was classifed as a Ta high grade disease. Thus, my doctor suggested that I should follow up with the standard recommendation of BCG (Bacillus Calmette-Guérin) a treatment, in my case post surgery, after the removal of the two tumours.

BCG (explanation directly from Bladder Cancer Canada site)

Once the bladder has healed from your diagnostic TURBT, a second TURBT may be performed within about six weeks if the tumour was aggressive. A drug called BCG (Bacillus Calmette-Guérin) may be inserted into your bladder through a catheter once a week for about six weeks (intravesical therapy).

BCG is a weakened form of the tuberculosis mycobacterium which stimulates immune responses within the bladder to destroy the cancer cells.

You’ll hold the BCG inside your bladder for up to two hours. Medical facilities have different treatment protocols, but you may be asked to spend time lying down and perhaps rolling on each side and front and back to ensure the chemical makes contact with the whole bladder lining.

Maintenance treatments of BCG may be prescribed to reduce the risk of the tumour recurring. This often involves a three-week treatment plan every three to six months for up to three years.

The initial treatments usually produce few if any side effects, but as the treatments progress, you may experience burning when urinating, a sense of urgency to urinate or the need to urinate more frequently. Some people report fatigue and a mild fever, achiness and nausea. There can be severe reactions, such as pain, inflammation and bleeding, but these are not the norm and diluted or reduced amounts of BCG can be given to help combat these side effects.

The Treatment Process

At Sunnybrook Hospital, urology department, I would visit the cystoscopy suite for my course of treatments. The first cycle was six treatments over six weeks beginning in May of 2014, with a break, and then three weeks of treatments, with breaks up to December 2015. I would make an effort to get in for the earliest appointment in the morning. The procedure involves dropping your drawers and then covering yourself up. The nurse will prep the area, provide some freezing gel for the urethra, insert and catheter and then put the BCG up into the bladder. It takes a matter of minutes. You then expected to return home, go about your day or lay down and “baste”. After two hours you can start to “drink like a fish (as one nurse suggested) and then start to pee the stuff out. My ritual was always going home and making a nice big pot of Lipton’s Chicken Noodle soup, followed by glasses of water all day long – with intermittent pee sessions – until everything was running clear by the evening. There was some burning session, but nothing too severe. The day of the BCG installation I felt pretty drained, groggy, just worn down. However, awakening the following day I felt a renewed feeling of energy and was back feeling top notch. In the last few installations of BCG I would actually see blood when I was voiding. This was surprising to me, because it was the only time that I had actually seen blood in the urine. All said and done after 18 installations (6-3-3-3-3) I was complete. After 18 installations, Dr. Kodama suggested that I call it “complete”. Touch wood – I’ve not had to return for any more BCG treatments.

Check ups…

I did return for Cystoscopies after BCG treatments on a regular 3 month interval, that then got extended to six months and now I have been on an annual visit in November for annual check ups. So far so good. Love to hear those words – “All Clear for another year, see you in twelve months”.

Note

As I have stated in previous blog posts on my bladder cancer journey, this is my own experience. I know in speaking with other patients that some had other experiences. Some folks really find the cystoscopies uncomfortable, or the BCG treatments intolerable. I just found that with each procedure the most important factor is to attempt to relax. If you can be as calm as possible, and not tense up muscles, you will have a fairly pain free experience. The other critical factor was to drink plenty of water – like a fish!  I always remarked that it is amazing what you get used to along the journey to beat bladder cancer!

@FergDevins