| Ch 11 | Page 5 / 16 | |
| Cancer other treatments |
Intravesical BCG | |
Intravesical BCG constitutes a non-specific treatment of localised non- invasive bladder carcinoma. The precise mechanism of action is not known but is probably related to the bladder inflammation it induces which may reject the abnormal cancer cells from the bladder wall.
Curative treatment of urothelial carcinoma in situ.
Prophylactic treatment of relapses from:
urothelial carcinoma limited to the mucosa,
urothelial carcinoma invading sub-epithelial connective tissue (pT1),
urothelial carcinoma in situ.
The treatment begins during the month after biopsy or transurethral resection, in the absence of any macroscopic urinary haemorrhage.
Induction treatment involves six weekly intravesical instillations, followed by consolidation treatment of one monthly instillation over 6 months.
A urethral catheter is installed in the bladder with the necessary surgical asepsis. After bladder drainage, a 50 ml suspension of BCG is slowly instilled by gravity, after which the catheter is removed. The patient must remain lying down for at least 15 minutes in supine position, on either side, or in prone position.
The patient can then stand up and can urinate the product after two hours.
This reaction is in the form of a generalised granulomatosis. BCG culture from the various affected organs is difficult and the pathology generally resembles a hypersensitivity inflammatory reaction. In this setting, allergic reaction arthritis may be observed.
Other manifestations can include higher fever (around 39°5 C) for a few hours, pneumonia, acute miliary BCG infection with hepatitis and cystitis.
The traumatic instillation with direct penetration into the general circulation promotes such septicaemia reactions. For this reason, an interval between resection and treatment, the absence of haemorrhage, the non traumatic set up of the urinary catheter and, for certain authors, the absence of prosthetic materials (such as hip, valve or pace-maker) require to be monitored.
When systemic manifestations occur and persist, certain authors institute antituberculosis treatment.
Intravesical administration of BCG may induce an inflammatory vesical response with fever, haematuria, pollakiura and transitory dysuria. This transitory phenomena is evidence that the inflammatory reaction has been attained in order to obtain the therapeutic benefit.
However, true urinary tract infections may occur, with bladder contracture, prostatitis, orchitis, epididymitis, ureteral obstruction or renal abscess. A small bladder syndrome may possibly be the consequence of these infectious reactions (very frequent micturitions due to a bladder capacity of less than 50 ml).
Systematic treatment might be necessary when stopping intravesical BCG treatment.
Although not a genuine BCG complication, regular cystoscopies should be carried out after the end of treatment. Initially superficial bladder cancer can invade and infiltrate without any major cystocopic modification.
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