Medication is injected into your bladder to encourage your immune system to attack and destroy the cancer cells.

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1 BCG Surgery What does it entail? Medication is injected into your bladder to encourage your immune system to attack and destroy the cancer cells. Your bladder will be removed and replaced, either with: a channel to allow urine to leave your body or a reconstructed bladder Will it be suitable for me? BCG is most effective where the cancer has not invaded the muscle wall. Surgery can be used to treat any bladder cancer, non-invasive or invasive. It may not be suitable if your kidneys are failing or if you are not fit enough to undergo major surgery. How successful will the treatment be? The success of your treatment depends on the type, stage and grade of your cancer. If you have a non-invasive cancer, there is a 70-80% chance that BCG will clear it by the time treatment is over However, there is still up to a 50% chance that the cancer will return, requiring surgery. If you your cancer is more complex, this rises to an over 80% chance that the cancer will return. BCG - Surgery Page 1

2 The success of your treatment depends on the type, stage and grade of your cancer. If you have a non-invasive cancer, there is an 80-90% chance that it will be cured by a cystectomy. If your cancer has invaded the muscle wall but not spread further, the cure rate is 60% and 80% If the cancer has spread further, this falls to between 20% and 60%, depending on individual circumstances Treatment / recovery time You will have weekly treatment in hospital as an outpatient for six weeks. After that, you may need to return to hospital once every six months for three years for further treatments. Not everybody reacts to BCG treatment in the same way, but many people are able to continue with their normal daily life during treatment, although it is not unusual to feel unwell immediately following treatment. You will probably need to stay in hospital for at least a week following your surgery. The length of time you spend in hospital will depend on what kind of diversion or reconstruction you have to replace your bladder. In general, the time you spend in hospital is likely to be around: one week for stoma with bag two weeks for continent diversion three weeks for reconstruction You should be able to drive after around six weeks, but a full recovery usually takes between three and six months. What are the side effects? Most people suffer side effects from BCG, but these usually wear off quickly after treatment. Common side effects include: urinary tract infections bladder discomfort flu like symptoms an urgent need to urinate BCG - Surgery Page 2

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8 blood in the urine There is a higher risk of your cancer returning after BCG treatment than if you have surgery. The side effects of surgery will vary, depending on whether you have a urinary diversion or reconstruction. The majority of patients do not suffer major complications following surgery. General effects of cystectomy include: you will have had major surgery and may be very tired following the operation. you may have bowel problems which can take time to resolve it is not uncommon to need time to come to terms with the changes to your body. in many cases, the surgery can affect your sex life and fertility fertile women are likely to go into menopause There is more detail about the side effects of urinary diversion or reconstruction in the table comparing these treatments. Life changes Once the treatment is over you will be able to return to your normal life, exactly as before. You will need to have check ups to ensure that your cancer has not returned for the rest of your life. If you have a urinary stoma you will either: need to wear a bag to catch your urine for the rest of your life or need to catheterise the diversion for the rest of your life If you have had a reconstruction, you will be able to return to life as before, though it may take many months to train your new bladder. In either case, you will need to have check ups to ensure that your cancer has not returned for the rest of your life. Detailed information More information about BCG More information about surgery BCG - Surgery Page 8

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