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

Published by Bupa's health information team, December 2008.

This factsheet is for people who are planning to have treatment for bladder tumours with mitomycin C or Bacille Calmette-Guérin (BCG), or who would like information about it.

Mitomycin C is a chemotherapy medicine that destroys cancer cells. BCG contains a weak form of the bacterium Mycobacterium bovis, which is also used to vaccinate against tuberculosis (TB). BCG works by encouraging your immune system to attack cancer cells.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About mitomycin C or BCG treatment
What are the alternatives?
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from mitomycin C or BCG treatment
What are the risks?
Further information
Questions and answers
Related topics
Sources

About mitomycin C or BCG treatment

The aim of mitomycin C and BCG treatment is to treat cancer and stop it from coming back. Mitomycin C and BCG are used to treat non-muscle-invasive bladder cancer (cancer of the bladder lining and not the muscle). BCG is usually used to treat the more aggressive type of cancer of the bladder lining. Your doctor will discuss with you which type of treatment is most suitable for you.

Mitomycin C or BCG is put inside the bladder and left in place for about two hours. This is called intravesical therapy. This type of therapy has fewer side-effects compared with medicines which are taken by mouth or are injected into a vein because the medicines don't pass (circulate) into the rest of the body.

What are the alternatives?

Mitomycin C or BCG treatment may be used on its own or as well as surgery. If they are given with surgery, mitomycin C is usually given immediately after bladder surgery, while BCG is usually given two weeks after bladder surgery. Depending on your medical circumstances you may be offered other types of chemotherapy.

Preparing for your procedure

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

Mitomycin C or BCG treatment is usually a day-case procedure. This means you have the treatment and go home the same day. The treatment is usually given once a week for six weeks.

Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

Mitomycin C or BCG treatment takes about two hours.

Your doctor will pass a thin tube (catheter) into your bladder through the tube through which urine flows out of the body (urethra). You doctor may apply a local anaesthetic gel around the entrance of your urethra beforehand to minimise any discomfort. You may feel the sensation of needing to pass urine as the catheter is fitted.

The mitomycin C or BCG is mixed with salt water (saline) to make about 50ml of solution. This is injected through the catheter into your bladder. The catheter may be left in place but closed shut so that the solution doesn't escape, or it may be taken out.

You will be asked to rest on a bed for about two hours.

At the end of the treatment, if the catheter is in place the fluid is drained from your bladder and the catheter is removed. If the catheter was taken out earlier, you will be asked to empty your bladder.

What to expect afterwards

When you feel ready, you will be able to go home. You can drive if you wish.

You may be given a date for a follow-up appointment.

Recovering from mitomycin C or BCG treatment

Follow your doctor's advice about returning to work and resuming your usual activities. Don't have sexual intercourse for at least the first 48 hours.

Some of the medicine may be present in your urine for the first 24 hours after treatment. You must wipe your urethral area with a moistened tissue or flannel and wash your hands thoroughly with soap and water after passing urine.

Drink plenty of clear fluids over 48 hours to help flush your bladder and reduce your risk of urinary infection.

Contact your GP or the hospital if you develop any of the following symptoms:

severe pain or pain that lasts for more than 48 hours
high temperature
burning sensation on passing urine or if your urine starts to smell
blood-stained urine
difficulty in passing urine
feeling sick or vomiting
generalised skin rash

You may have developed a reaction to the medicines or a urinary tract infection (UTI) and may need further treatment.

What are the risks?

Mitomycin C or BCG treatment is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment.

Side-effects of mitomycin or BCG treatment include:

feeling some discomfort when passing urine - this usually settles within a few hours
feeling mild stinging when passing urine - this may last 24 hours

Complications

This is when problems occur during or after the procedure. Most people are not affected.

Complications of mitomycin C or BCG treatment are uncommon but can include:

urinary tract or bladder infection (cystitis) - you may need antibiotics to treat this
damage to the urethra - this may require treatment with medicines or surgery
reaction from BCG - very rarely, the weakened bacteria in the BCG can cause an infection and may need treatment with anti-tuberculosis medicines
reaction from mitomycin C - very rarely, the mitomycin C may pass into the bloodstream and affect the bone marrow or cause a skin rash

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

Further information

Cancerbackup
0808 800 1234
www.cancerbackup.org.uk