Bacillus Calmette-Guerin (BCG) Treatment

What is BCG treatment?

Bacillus Calmette-Guerin (BCG) treatment is a type of intravesical (in your bladder) immunotherapy. This liquid drug is made from a strain of Mycobacterium bovis — the same bacterium used to create the tuberculosis vaccine. When used in medicine, Mycobacterium bovis is weakened to reduce harm to your body.

BCG treatment is usually given after TURBT (transurethral resection of bladder tumor), which is a bladder surgery to remove any visible cancer.

What conditions are treated with BCG treatment?

BCG treatment is used to address early-stage bladder cancer. This includes bladder cancers that haven’t invaded your bladder wall muscle, such as carcinoma in situ (in its original location) bladder cancers and non-muscle invasive bladder cancers (NMIBCs). BCG treatment isn’t effective against bladder cancer that has metastasized (spread to other parts of your body).

Clinical trials are currently underway to explore BCG treatment for fibromyalgia and diabetes. Experts believe that BCG treatment may increase cytokines (immune-signaling molecules), which could potentially benefit people with these conditions. More research is needed in these areas, though.

Is BCG treatment a form of chemotherapy?

No. Although intravesical immunotherapy and intravesical chemotherapy are given the same way, these two treatments use different types of drugs. While chemotherapy drugs attack cancer cells directly, immunotherapy drugs harness the power of your immune system.

How common is BCG treatment?

BCG treatment is currently the most common intravesical immunotherapy used to fight early-stage bladder cancer.

How should I prepare for BCG treatment for bladder cancer?

Prior to BCG treatment, your healthcare provider will give you a list of specific guidelines to help you prepare. In general, you should avoid caffeinated beverages and diuretics (water pills) for four hours before your appointment. When you arrive for your procedure, you should pee to ensure that your bladder is empty.

What happens during BCG cancer treatment?

Before beginning BCG treatment, local anesthesia is given to numb the area and keep you comfortable. Next, your healthcare provider will place a catheter into your urethra (the hole you pee from) and inject the liquid BCG solution into your bladder.

The BCG solution needs to come in contact with cancer cells to kill them. So, once the medication is injected, your healthcare provider will remove the catheter and ask you to lie on your back, stomach and both sides for 15 minutes each.

When the process is complete, you’re free to leave your appointment. However, you should avoid peeing for at least one more hour.

How long do you hold BCG in your bladder?

Once the BCG solution is injected into your bladder, you’ll hold it for a total of two hours. After this point, you’ll be able to pee.

What does BCG do to the bladder?

When the BCG solution enters your bladder, your immune system cells begin to attack the cancer cells in your bladder.

BCG treatment schedule

The initial BCG cancer treatment occurs weekly for six weeks. This is called induction therapy.

If the treatment is working, your doctor may prescribe BCG maintenance therapy. Maintenance therapy is given once a week for three weeks at the three-, six- and 12-month marks. For some people, this may be continued up to three years.

Is BCG treatment contagious to others?

Yes. The drugs used for BCG treatment contain live bacteria, which can be passed to other people. To reduce the risk of contamination, follow these instructions for six hours after every BCG treatment:

• Don’t use public toilets.
• Drink lots of fluids to dilute your pee.
• Sit down on the toilet to avoid splashing.
• After you pee, add 2 cups of undiluted bleach to the toilet, close the lid, wait 15 to 20 minutes and then flush.
• If you have urinary incontinence (loss of bladder control), immediately wash your clothes in a washing machine. Don’t wash them with other clothes.
• If you wear an incontinence pad, pour bleach on the pad, allow it to soak in, then place it in a plastic bag and discard it in the trash.

Typically, you’ll need to refrain from having sex for a few days after each BCG treatment session. In addition, use a condom any time you have sex throughout the entire course of treatment. Ask your healthcare provider about specific guidelines regarding sex.

What are the advantages of BCG treatment?

When performed in combination with TURBT, BCG treatment is the most effective treatment for early-stage bladder cancer. BCG cancer treatment can slow tumor growth and reduce your chance of needing a cystectomy in the future.

What are some potential BCG treatment side effects?

It’s normal to develop certain side effects within the first 24 hours after BCG treatment. These side effects may include:

• A small amount of blood in your pee.
• Low-grade fever (99-100 degrees Fahrenheit or 37.22-37.77 degrees Celsius).
• Tiredness.
• A burning sensation when you pee.
• Needing to pee more often (frequent urination).
• Muscle pain.
• Joint pain.

Your healthcare provider will give you medications to manage these side effects. You can also take over-the-counter (OTC) pain relievers to reduce fever and ease your discomfort.

Less commonly, you may experience additional complications, including:

• Skin rash.
• Fever higher than 101.3 degrees Fahrenheit (38.5 degrees Celsius).
• Nausea and vomiting.
• Loss of bladder control.
• Bladder spasms.
• Inability to pee.
• Urinary tract infections.
• Inflammation of your testicles.
• Ureteral obstruction.
• Bladder contracture (thickening or scarring of your bladder muscles).
• Necrosis (cell death).
• BCG sepsis (a tuberculosis-like illness that can happen if BCG solution enters your bloodstream).
• Neutropenia (a low white blood cell count).
• BCG-induced hypersensitivity pneumonitis (lung inflammation).
• Hepatitis.

If you develop severe pain, high fever or signs of infection, call your healthcare provider right away.

Is there a risk of bladder cancer after BCG treatment?

Like most cancers, bladder cancer can potentially return after treatment. Statistically, cancer will recur (return) in up to 40% of people who receive BCG treatment. It’s important to note, however, that even if the cancer comes back, it may not progress.

Low-grade bladder cancer usually doesn’t spread to other areas of your body. But people who have low-grade bladder cancer have a higher risk of developing other low-grade cancers throughout their lifetimes.

Less often, aggressive bladder cancer can develop after BCG treatment. If this happens, cystectomy (surgery to remove your bladder) is usually recommended.

How long is recovery after each BCG treatment session?

Most BCG treatment side effects go away in two to three days. If your symptoms are severe — or if they last longer than 72 hours — call your healthcare provider for guidance.

When can I go back to work or school?

In general, most people can return to work or school in one to two days. But, everyone’s experience is different. Talk to your healthcare provider about what’s right for you.

When should I see my healthcare provider?

It’s normal to have a low-grade fever and mild achiness after BCG treatment. However, you should call your healthcare provider if you develop:

• A fever higher than 101.3 degrees Fahrenheit (38.5 degrees Celsius).
• Chills.
• Severe shivering.
• Bladder spasms.

A note from Cleveland Clinic

For people with early-stage bladder cancer, BCG cancer treatment is the go-to approach. Before deciding on treatment, talk with your healthcare provider about benefits, as well as potential risks and complications. A bladder cancer diagnosis can feel overwhelming. Consider joining a support group to get to know others who’re going through the same thing. Learning all you can about your treatment options can help you make an informed decision regarding your health.