Hello Jms0300,
I'm sorry to say that I found nothing in the literature suggesting
using BCG for treatment of benign bladder tumors.
?The definition of a tumor is a mass of quickly and abnormally
growing cells. Tumors can be either benign or malignant. Benign tumors
have uncontrolled cell growth, but without any invasion into normal
tissues and without any spread. A malignant tumor is called cancer
when these tumor cells gain the propensity to invade tissues and
spread locally as well as to distant parts of the body. In this sense,
bladder cancer occurs when cells in the lining of the bladder grow
uncontrollably and form tumors that can invade normal tissues and
spread to other parts of the body.?
http://www.oncolink.com/types/article.cfm?c=21&s=66&ss=768&id=9464
?Fortunately, 85% of bladder tumors are superficial or minimally
invasive into the bladder wall and can be readily treated with
telescopic techniques, which remove the tumors through the urethra. At
times, chemotherapy is placed in the bladder to treat or prevent
recurrences. In 15% of patients, however, the tumor has invaded into
the bladder wall and more aggressive treatment is required. Therapy
may involve a combination of chemotherapy and bladder removal or
bladder removal alone.?
http://www.whcenter.org/body.cfm?id=1928
?? Papillomas are a benign type of papillary urothelial tumor. Since
they are not cancerous, these tumors never spread to other parts of
the body. They are successfully removed by surgery and rarely grow
back. Patients with papillomas very rarely develop another papillary
tumor elsewhere in their urinary system.
? Papillary urothelial neoplasms of low malignant potential are
cancers. These are usually successfully treated by surgical removal.
But it is not unusual for patients with these tumors to develop one or
more papillary tumors later on in other areas of their urinary system.
Most of these other tumors resemble the original tumor, but
occasionally the new tumor may be cancerous or even invasive.?
http://www.cancer.org/docroot/cri/content/cri_2_4_1x_what_is_bladder_cancer_44.asp
However, benign papillomas can become cancerous.
?Q. Are all bladder tumors malignant (cancerous)?
Dr. Green: No; however, 90% are.
?Q. Are there different types of bladder tumors?
Dr. Green: Yes; however, for the purpose of this article we will
confine our discussion to "transitional papillary tumors". Other
types of bladder tumors are: 1) inverted papilloma, 2) nonpapillary
carcinomas, such as adenocarcinoma, 3) bladder cancer associated with
other disease, e.g., bladder stones, diverticula, 4) metastatic cancer
to the bladder, 5) cancer in situ, 6) involvement of ureters, urethra,
and renal pelvis, and 7) sarcomas.?
http://www.urologyinstitute.com/html/bladder_cancer.html
?Benign tumors are not cancer. Usually, doctors can remove them. Cells
from benign tumors do not spread to other parts of the body. In most
cases, benign tumors do not come back after they are removed. Most
important, benign tumors are rarely a threat to life.?
http://www.cancercompass.com/bladder-cancer-information.htm
BCG
===
Fm my research, it appears that BCG is not used for benign tumors.
Urologists prefer to surgically remove benign tumors. BCG works by
stimulating the body to build antibodies that destroy malignant
tumors, and I have seen no evidence that BCG can destroy benign tumor
cells.
?Immunotherapy, also known as biological therapy, uses the body's
natural ability (immune system) to fight cancer and is most often used
after TUR for superficial bladder cancer to prevent the cancer from
coming back.
BCG is the most common form of immunotherapy. BCG solution contains
live, weakened bacteria that stimulate the immune system to kill
cancer cells in the bladder. The bladder is filled with the solution
through a catheter and left for about two hours. This treatment is
usually done once a week for about six weeks. Interferon is another
form of biologic therapy that involves administration of large amounts
of a synthetic protein normally made by the body to activate and
energize the immune system. Recent studies suggest that a combination
of BCG plus Interferon may be particularly active against aggressive
or refractory superficial bladder cancer.?
http://www.uihealthcare.com/topics/medicaldepartments/urology/bladdercancerfaq/
?Biological therapy Often a form of intravesical chemotherapy,
biological therapy uses materials made by the body or made in a
laboratory to boost, direct or restore the body's natural defenses
against the cancer. When several tumors are present in the bladder or
when there is a risk that the cancer will recur, TUR may be followed
by treatment with drugs. The doctor may put a solution containing the
bacteria bacillus Calmette-Guerin (BCG), a form of biological therapy,
directly into the bladder via a catheter (intravesical biological
therapy).?
http://ww3.komotv.com/global/story.asp?s=1230291
BCG Side Effects:
?Bacillus Calmette-Guérin (Ba-SIL-es Kal-met Geh-rin) (BCG) is used as
a solution that is run through a tube (instilled through a catheter)
into the bladder to treat bladder cancer. The exact way it works
against cancer is not known, but it may work by stimulating the body's
immune system.
BCG is to be administered only by or under the immediate supervision
of your doctor. It is available in the following dosage form:
When receiving BCG it is especially important that your health care
professional know if you are taking any of the following:
? Amphotericin B by injection (e.g., Fungizone) or
? Antineoplastics (cancer medicine) or
? Antithyroid agents (medicine for overactive thyroid) or
? Azathioprine (e.g., Imuran) or
? Chlorambucil (e.g., Leukeran) or
? Chloramphenicol (e.g., Chloromycetin) or
? Colchicine or
? Corticosteroids (cortisone-like medicine) or
? Cyclophosphamide (e.g., Cytoxan) or
? Cyclosporine (e.g., Sandimmune) or
? Flucytosine (e.g., Ancobon) or
? Ganciclovir (e.g., Cytovene) or
? Interferon (e.g., Intron A, Roferon-A) or
? Mercaptopurine (e.g., Purinethol) or
? Methotrexate (e.g., Mexate) or
? Muromonab-CD3 (e.g., Orthoclone OKT3) or
? Plicamycin (e.g., Mithracin) or
? Zidovudine (e.g., AZT, Retrovir)?Because these medicines reduce the
body's natural immunity, they may prevent BCG from stimulating the
immune system and will cause it to be less effective. In addition, the
risk of infection may be increased
Other medical problems
The presence of other medical problems may affect the use of BCG. Make
sure you tell your doctor if you have any other medical problems,
especially:
? Fever?Infection may be present and could cause problems
? Immunity problems?BCG treatment is less effective and there is a
risk of infection
? Urinary tract infection?Infection and irritation of the bladder may occur
BCG is a live product. In other words, it contains active bacteria
that can cause infection. Some bacteria will be present for several
hours in urine that you pass after each treatment with BCG.?
http://www.mayoclinic.com/health/drug-information/DR202079
Benign Tumors:
==============
?Update 2006: Two articles support 'watchful waiting instead of
automatic removal of low grade superficial bladder tumors:
Expectant treatment of small, recurrent, low-grade, noninvasive tumors
of the urinary bladder,.."As long as the tumors are low grade, the
risk of invasion or metastasis is zero. Every small papillary tumor
does not require removal when observed. Some of these tumors grow very
slowly and, with proper reassurance, can be safely monitored."Mark
Soloway; Miami; Urologic Oncology: Seminars and Original
Investigations Volume 24, Issue 1 , January-February 2006, Pages
58-61?
http://blcwebcafe.org/superficialblca.asp
"Treatment:
The choice of an appropriate treatment is based on the stage of the
tumor, the severity of the symptoms, and the presence of other medical
conditions. Generally, superficial tumors (stages 0 and I) are treated
by removing the lesion (without removal of the rest of the bladder)
and by sometimes administering local (directly into the bladder)
chemotherapy. However, because the risk of recurrence is so high (70
-100%), people with bladder cancer require constant follow-up for the
rest of their lives.
The treatment for stage II bladder tumors may involve removal of the
tumor and a trial of BCG immunotherapy (see below) with serial
follow-up. However, most people with stage II and those with stage III
tumors will require bladder removal (radical cystectomy). In some
patients with stage III tumors who opt not to have surgery or who
cannot tolerate surgery, a combination of chemotherapy and radiation
may be appropriate. Most patients with stage IV tumors cannot be cured
and surgery is not indicated. In these patients, chemotherapy is often
considered."
http://www.shands.org/health/information/article/000486.htm
Malignant Tumors
================
It appears that BCG can be effective in some types of malignant
tumors, in patients that have recurring tumors and with in situ
carcinoma, but not without risk:
?Although the observation of a lower frequency of bladder cancer in
patients with tuberculosis dates back to the 19th century, the use of
BCG as a bladder cancer immunotherapy was seriously considered first
in the mid-1970s. The over 25-year experience with BCG and many
clinical trials have shown that BCG is in general more effective than
chemotherapy.?
?BCG has proven two times more effective than chemotherapy for
prophylaxis. However, BCG is still used more cautiously than
chemotherapy, due to the low but serious risk of systemic BCG
infection, especially if administered in a setting of recent surgery
or traumatic catheterization.?
http://www.uihealthcare.com/news/currents/vol3issue3/5bladdertumors.html
?Bacillus Calmette-Guérin (BCG) immunotherapy has been confirmed to be
highly effective in the reduction of tumor recurrence, the treatment
of residual papillary transitional cell carcinoma and the treatment of
carcinoma in situ (CIS). The response rate in the treatment of the
papillary disease averages 55%, and for CIS 73%. In the prevention of
tumor recurrence the relative benefit of BCG is 45%. A direct
prospective randomized comparison of BCG with intravesical
chemotherapy has found it to be significantly superior to thiotepa, to
doxorubicin and to mitomycin C when only patients with intermediate
and high risk for recurrence were treated. In studies including
patients with low recurrence risk, no advantage for BCG was found.?
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=52386&ProduktNr=224083&Ausgabe=227838&filename=52386.pdf
"Biological therapy
Biological therapy stimulates your body's own immune system to fight
cancer. It's usually used after TUR to help prevent superficial
bladder cancer from recurring. Bacillus Calmette-Guerin (BCG) is the
most commonly used immune stimulant. It binds to your bladder, where
it triggers a response that inhibits the formation and growth of
tumors. BCG is administered directly into your bladder using a small,
flexible tube (catheter) for two hours once a week. Treatment may last
six or more weeks.
During treatment with BCG, you may have some bladder irritation or
blood in your urine and feel as if you have the flu. Your doctor may
suggest a medication to help reduce some of these signs and symptoms."
http://www.mayoclinic.com/health/bladder-cancer/DS00177/DSECTION=7
?Patients CIS of the urinary bladder are usually treated
conservatively. Most patients are treated with transurethral
resection of the exophytic tumor(s) followed by intravesical treatment
with bacillus Calmette-Guerin (BCG). The majority of patients (more
than 50%) will develop invasive disease after conservative surgery
alone. The addition of intravesical BCG can significantly reduce the
rate of recurrence and may increase the overall survival rate.
Actually, intravesical BCG therapy is the first line treatment for
diffuse CIS, and it can produce > 70% complete response rate for more
than one year. The five-year control rate after BCG treatment is more
than 60%. In order for BCG to be effective, the tumor burden should be
relatively small, and there must be direct contact between the
medication and the tumor.?
http://www.cancerlinksusa.com/bladder/articles/carcinoma_in_situ.asp
?In case of recurrence, or also used as first line treatment, BCG
(bacillus Calmette-Guerin, an immunotherapy) has been shown to be most
effective, especially with carcinoma in situ. Compared with TUR alone
in patients with Ta and T1 lesions, treatment with BCG delayed
progression to muscle-invasive and/or metastatic disease, improved
bladder preservation, and decreased the risk of death from bladder
cancer. New evidence is showing that maintentance therapy as defined
in Dr. Lamm's protocol has further lowered risk of recurrence.?
http://blcwebcafe.org/superficialblca.asp
?Adjuvant intravesical bacillus Calmette-Guérin (BCG) therapy is a
well-established and successful adjuvant immunotherapy in the
treatment of superficial bladder cancer. Although the function of
natural killer (NK) cells in other immunotherapeutic regimens (e.g.,
lymphokine-activated killer [LAK] cell or interleukin-2 [IL-2]
therapy) has been established, the contribution of NK cells to
effective BCG immunotherapy is not clear. We used a human in vitro
system to analyze the role of NK cells in BCG-induced cellular
cytotoxicity. After stimulation of mononuclear cells with BCG for 7
days, these BCG-activated killer (BAK) cells displayed substantial
cytotoxicity against bladder tumor cells. Magnetic depletion
experiments and fluorescence activated cell sorting revealed that NK
cells were the major effector cell population. To address NK cell
function in vivo, we studied a syngeneic orthotopic murine bladder
cancer model and compared BCG immunotherapy in C57BL/6 wild-type mice,
NK-deficient beige mice and mice treated with anti-NK1.1 monoclonal
antibody. Four weekly instillations of viable BCG significantly
prolonged survival in wild-type mice compared with control mice
treated with solvent alone. In contrast, BCG therapy was completely
ineffective in NK-deficient beige mice and in mice treated with
anti-NK1.1 monoclonal antibody. These findings suggest a key role for
NK cells during BCG immunotherapy. © 2001 Wiley-Liss, Inc.?
http://www3.interscience.wiley.com/cgi-bin/abstract/80002211/ABSTRACT
?After resection, T1, Tis, high-grade Ta, and residual Ta lesions
exhibit a high risk of both recurrence (80%-100%) and progression
(about 50%). In these cases, adjuvant intravesical therapy is
warranted. The standard intravesical therapy is bacille
Calmette-Guérin (BCG)?
http://www.postgradmed.com/issues/2005/10_05/sonpavde.htm
?Adjuvant intravesical drug therapy after TUR is commonly prescribed
for patients with tumors that are large, multiple, high grade or
superficially invasive. Intravesical therapy consists of drugs placed
directly into the bladder through a urethral catheter, in an attempt
to minimize the risk of tumor recurrence and progression. The most
commonly used intravesical drugs are Bacille Calmette-Guerin (BCG) and
Mitomycin C. Maintenance therapy (repeated therapy on a regular basis)
with BCG or another drug administered intermittently following initial
diagnosis and treatment of superficial bladder tumor decreases the
likelihood of recurrence. About 50-68% of patients with superficial
bladder cancer have a very good response to intravesical therapy.?
http://pathology2.jhu.edu/bladder_cancer/Treatmnt.cfm
Additional Information:
http://www.uihealthcare.com/news/currents/vol4issue4/urinarytractcytology.html
http://www.rxlist.com/cgi/generic2/bcg_ad.htm
http://www.cancer.med.umich.edu/learn/bladtum.htm
http://www.medicalnewstoday.com/medicalnews.php?newsid=37999&nfid=rssfeeds
http://www.oncolink.com/resources/article.cfm?c=3&s=8&ss=23&Year=2003&Month=11&id=10242
http://www.clevelandclinic.org/health/health-info/docs/2900/2917.asp?index=10648&src=news
As far as recommending medical centers, these are excellent choices:
Duke Medical Center, Durham, NC
http://dukehealth1.org/surgery/div_urology.asp
Scheduling Appointments: All visits are by appointment only and can be
scheduled by calling the Appointment Hub Coordinator at (919)
684-2446. Please have demographic and insurance information available
when you call.
http://dukehealth1.org/surgery/urology_pc.asp
Johns Hopkins, Baltimore, Maryland
http://pathology2.jhu.edu/bladder_cancer/index.cfm
Appointments:
http://pathology2.jhu.edu/bladder_cancer/appts.cfm
Not the east coast, but?
Cleveland Clinic/ GLICKMAN UROLOGICAL INSTITUTE
http://www.clevelandclinic.org/quality/outcomes/urologicalInstitute/bladder.htm
http://www.clevelandclinic.org/
I hope this has helped you. Not everyone is pleased to receive a
negative answer, but I found no medical literature citing the use of
BCG for benign tumors. Your doctor?s advice seems reasonable, but you
may want to consider a second opinion at one of the respected medical
centers I have posted. Medical centers affiliated with teaching
hospitals are very current in their knowledge of the latest therapies.
If any part of my answer is unclear, please request an Answer
Clarification, and allow me to respond, before you rate. I will be
happy to assist you further, before you rate my answer.
Good luck - I wish your husband the best!
Sincerely, Crabcakes
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============
BCG + benign bladder tumors
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