Bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG)

About bladder treatment with mitomycin C or BCG

Bladder treatment with mitomycin C or BCG is usually given after having a transurethral resection of bladder tumour (TURBT). The aim of the treatment is to destroy any remaining cancer cells and reduce the chance of the cancer coming back as well as to prevent the tumour cells spreading elsewhere in your bladder.

Mitomycin C is a chemotherapy medicine and works by killing cancer cells. You may have it as a single dose within six hours of surgery or as a weekly course of treatment for six weeks. Sometimes, for early stage bladder cancer, treatment with mitomycin C may be used alone, without surgery.

BCG is a vaccine for tuberculosis. It contains a weakened form of the bacterium Mycobacterium bovis and works by encouraging your immune system to attack cancer cells. BCG treatment should be started no sooner than two weeks after TURBT surgery. You usually have BCG treatment weekly for six weeks and then a repeat treatment every few weeks or months for up to three years. Guidance varies on the exact length of time you need to stay on this therapy but it’s generally accepted that it should be for at least 12 months, but sometimes longer.

Your doctor will discuss with you which type of treatment is most suitable for you.

What are the alternatives to bladder treatment with mitomycin C or BCG?

Depending on your medical circumstances you may be offered other types of bladder treatment.

  • Bladder treatment with other types of chemotherapy medicines, such as epirubicin or doxorubicin.
  • Photodynamic therapy. This involves using a chemotherapy medicine that is activated when light shines on it. The medicine is either put into your bladder or injected into a vein.

The following experimental treatments may also be available, but may not be suitable for some people.

  • Electromotive drug administration (EMDA). This is being tested as a treatment for early stage bladder cancer, where researchers are looking to see if the therapy improves how well mitomycin C works on the lining of the bladder. EMDA may be used if BCG hasn’t worked and where you’re at high risk of uncontrolled cancer growth and you can’t have a cystectomy (bladder removal).
  • Hyperthermia. This treatment is currently undergoing trials in people with early stage transitional cell bladder cancer. It involves heating your bladder to about 42°C and washing mitomycin C through. Results from earlier trials have shown that this may be a useful treatment for people with a high risk of early bladder cancer coming back, but doctors aren’t yet sure how well it will work.
  • Biological therapy. These treatments use your body's natural substances to interfere with the way cells interact with each other, to attack or control the growth of cancer cells, but are rarely used.

Preparing for bladder treatment with mitomycin C or BCG

Your doctor will discuss with you what will happen before, during and after your treatment, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the treatment. This will help you to be informed, so you can give your consent for the treatment to go ahead, which you may be asked to do by signing a consent form.

You will be asked not to drink for a few hours before mitomycin C or BCG treatment. This is to stop any urine collecting in your bladder during the treatment and diluting the medicines.

Mitomycin C or BCG treatment is usually done as a day-case procedure. This means you have the treatment and go home the same day. If you need more information, you may want to ask if there is a specialist urology nurse in the unit to speak to.

What happens during bladder treatment with mitomycin C or BCG?

You will have a thin tube (catheter) passed through your urethra (the tube that carries urine from your bladder to the outside) and into your bladder. This is not painful but can be a little uncomfortable.

Your doctor will inject mitomycin C or BCG through the catheter and into your bladder. The catheter may then be taken out. You will have to try not to pass urine for one to two hours. This will give the medicines time to act on the lining of your bladder.

Afterwards, you will be asked to empty your bladder. If the catheter is still in place, the fluid will be drained and the catheter removed.

What to expect afterwards

You will usually be able to go home when you feel ready.

You may be booked for the whole course of weekly treatments, then receive an appointment for a cystoscopy, which is a procedure that allows your doctor to look inside your bladder.

Recovering from bladder treatment with mitomycin C or BCG

Follow your doctor's advice about returning to work and resuming your usual activities.

After treatment, some of the medicine may be present in your urine for up to six hours. It's important to wipe the area around your urethra with a moistened tissue or flannel and wash your hands thoroughly with soap and water after passing urine. Sit to urinate and afterwards put bleach in the toilet and leave it for 15 minutes before flushing.

Drink plenty of clear fluids over the first couple of days to help flush your bladder and reduce your risk of getting a urinary infection.

You should use a condom during sex for the first 48 hours after treatment. This will protect your partner from any medicines that may be present in your semen, if you’re a man, or vaginal fluid, if you’re a woman. It's best not to become pregnant or father a child while having bladder treatment with mitomycin C or BCG as the effect of the treatment on a developing baby isn't known. Use contraception during your treatment and for six weeks afterwards. Ask your doctor for more information.

What are the risks?

As with every procedure, there are some risks associated with bladder treatment with mitomycin C or BCG. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of mitomycin C or BCG treatment include:

  • a burning sensation in your bladder
  • feeling some pain or soreness when passing urine
  • feeling the need to pass urine very often
  • blood-stained urine

Complications

Complications are when problems occur during or after the procedure. Complications of bladder treatment with mitomycin C or BCG are uncommon, but can include having a reaction to the medicines.

  • About one in 10 people having bladder treatment with mitomycin C develop a rash on their hands or feet.
  • About one in 100 people having bladder treatment with BCG develop the symptoms of tuberculosis, such as fever and chills, joint pain and a skin rash.

Contact your doctor for advice if you:

  • have a fever (a temperature higher than 37.5°C)
  • feel sick or vomit
  • have severe pain or pain that lasts for more than 48 hours

You may develop a reaction to the medicines or get a urinary tract infection (UTI). If this happens, you may need further treatment. Speak to your doctor for more information about the complications of treatment with mitomycin C or BCG.

Do I need to follow any special instructions after bladder treatment with Bacille Calmette-Guérin (BCG)?

Answer

Yes, you will have to take some special precautions to prevent getting an infection. You will also need to take steps to avoid passing the BCG bacteria to those who might have reduced immunity (for example, elderly people, pregnant women, and those having certain medical treatments).

Explanation

BCG is an immunotherapy that contains a weak form of the bacterium Mycobacterium bovis, which is also used to vaccinate against tuberculosis. BCG works by encouraging your immune system to attack cancer cells. The bacteria may be present in your urine for at least six hours after the treatment. It's best to take the following precautions for at least the first 24 hours.

  • Men should sit down to pass urine, so that the chance of splashing is reduced.
  • After passing urine, wipe your urethral area with a moistened tissue or flannel.
  • Try not to get any urine on your hands.
  • After going to the toilet, pour about half a pint of neat bleach into the toilet bowel and leave it for 15 minutes before flushing to stop live bacteria entering the sewer system.

Wash your hands thoroughly with soap and water after going to the toilet. It's best not to become pregnant or father a child while having bladder treatment with BCG as the effect of the treatment on a developing baby isn't known. Use contraception during your treatment and for six weeks afterwards. Ask your doctor for more information.

Will my bladder function normally after having bladder treatment with mitomycin C or Bacille Calmette-Guérin (BCG)?

Answer

During your recovery from mitomycin C or BCG treatment, you may feel the need to pass urine often and more urgently.

Explanation

Mitomycin C and BCG treatment works by attacking the cells in your bladder lining. For this reason, the main side-effect of mitomycin C or BCG bladder treatment is bladder irritation. Symptoms are similar to having a urine infection. Your doctor will recommend that you drink plenty of fluids to help flush your bladder and reduce your risk of infection. As a result, you will need to pass urine more often than usual.

Otherwise, you can expect your bladder function to return to normal after you have made a full recovery. This can take up to three weeks.

What happens if I don't want to have bladder treatment with Bacille Calmette-Guérin (BCG)?

Answer

Your doctor will recommend the best treatment for you and explain suitable alternatives. Your treatment options will depend on the type of bladder cancer you have and whether or not the cancer has spread outside the lining of your bladder wall.

Explanation

If the bladder cancer hasn't spread into the muscle of your bladder wall, there are several treatment options available. These include surgery and treatment with mitomycin C or BCG. There are also a number of experimental therapies that you may want to ask your doctor about. However, if your cancer is at a stage known as carcinoma in situ (CIS) – very early, high grade, cancer cells have been detected only in the innermost layer of the bladder lining – BCG is the treatment of choice.

Generally, mitomycin C and BCG treatments complement surgery and aren't usually recommended on their own. Your doctor will recommend the best treatment for your particular medical circumstances and explain the benefits and risks of the procedure. He or she will explain what may happen if you don't have the recommended treatment and discuss alternative treatment options with you.

You're free to choose not to have the recommended treatment, have a different treatment or not to have any treatment at all. You don't have to give any reasons for your decision but it can help your doctor know your concerns so that he or she can give you the best advice.

If you have any questions, don't be afraid to ask your doctor. It often helps to make a list of the questions you want to ask and to take a close relative or friend with you to remind you of the things you want to know.

You can always ask for more time to decide about the treatment if you feel that you can't make a decision immediately.