Bacillus Calmette-Guérin (BCG) is a form of immunotherapy employed primarily in the management of non-muscle invasive bladder cancer (NMIBC). This treatment utilizes a weakened strain of bacteria to stimulate the body’s own immune system against cancer cells in the bladder lining. Maintenance therapy refers to subsequent treatments designed to prevent cancer recurrence after an initial course.
Why Maintenance BCG is Used
BCG functions as an immunotherapy, prompting the body’s immune system to identify and attack cancer cells directly within the bladder. It encourages immune cells to become highly active in the bladder lining, where they may eliminate any remaining cancer cells. This localized immune response targets the cancer without affecting the entire body like systemic treatments.
Maintenance therapy is important for non-muscle invasive bladder cancer due to its high propensity for recurrence. Even after initial tumor removal through surgery, microscopic cancer cells can remain, leading to new growth. Without maintenance therapy, the risk of cancer returning is substantial, and it can progress to more aggressive forms.
Administering BCG in a maintenance schedule significantly lowers the chance of recurrence and can delay disease progression. This approach provides sustained immune surveillance within the bladder, helping to keep cancer cells in check. For patients with intermediate and high-risk tumors, intravesical BCG has shown superiority over surgery alone or combined with chemotherapy in preventing recurrence.
The Typical BCG Maintenance Schedule
The standard BCG regimen begins with an “induction phase,” followed by “maintenance phases” for long-term protection. The induction phase involves six weekly instillations of the BCG solution directly into the bladder. This initial course aims to establish a strong immune reaction against existing cancer cells.
Following induction, the common maintenance schedule involves repeated series of instillations. Patients usually receive three weekly doses at specific intervals: 3, 6, 12, 18, 24, 30, and 36 months. This schedule sustains the immune response over several years.
The exact duration and frequency of the maintenance schedule vary based on individual patient risk factors, such as tumor grade and stage. Guidelines from organizations like the American Urological Association (AUA) and the European Association of Urology (EAU) provide recommendations. For high-risk tumors, three years of maintenance therapy has shown more effective recurrence reduction than one year.
While a three-year maintenance schedule is often recommended for high-risk patients, not all individuals complete the full regimen. Factors like treatment efficacy or side effects can influence adherence. Healthcare providers tailor the treatment plan to each patient’s specific needs and tolerance.
What to Expect During BCG Treatment
BCG is administered intravesically, delivered directly into the bladder through a catheter. Before the procedure, patients may restrict fluid intake for a few hours to ensure the bladder is not overly full, allowing sufficient contact with the bladder lining.
During treatment, a healthcare professional inserts the catheter through the urethra into the bladder. The liquid BCG solution is instilled, and the catheter is removed. Patients are asked to hold the solution in their bladder for up to two hours for adequate contact time. Some centers suggest changing positions periodically to ensure the solution reaches all parts of the bladder.
After holding, the patient urinates to expel the solution. For several hours following treatment, precautions are necessary because the vaccine contains bacteria. This includes careful hygiene, such as washing hands thoroughly and cleaning the toilet after use, to prevent potential spread. Increased fluid intake after urination is often recommended to help flush the bladder.
Common side effects include bladder irritation, frequent or urgent urination, burning or pain during urination, and flu-like symptoms such as chills, mild fever, or fatigue. These symptoms begin a few hours after treatment and may last one to three days. Patients should contact their healthcare provider for severe or unusual symptoms, or if a fever exceeds a certain temperature.
Life After the Maintenance Schedule
Even after completing the BCG maintenance schedule, ongoing surveillance monitors for cancer recurrence. This long-term follow-up is standard care for individuals with a history of non-muscle invasive bladder cancer. Regular monitoring helps detect returning cancer at an early, more manageable stage.
Follow-up procedures include periodic cystoscopies, a visual examination of the bladder’s interior using a thin scope. These allow direct inspection for suspicious areas. Urine cytology tests are also performed, examining urine samples for abnormal cells.
Adherence to these long-term follow-up appointments is important for continued health monitoring. Patients are encouraged to report any new or worsening symptoms, such as changes in urination patterns or blood in the urine, to their healthcare team promptly.
For many patients who complete maintenance therapy, the long-term prognosis is favorable, especially when cancer was detected and treated early. While BCG reduces recurrence risk, continued vigilance through surveillance helps manage new developments. Ongoing monitoring ensures sustained remission and addresses potential issues efficiently.