Bacillus Calmette-Guerin (BCG) for bladder cancer

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	Why It Is Used
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It is not clear how Bacillus Calmette-Guerin (BCG) works to treat bladder cancer. It may stimulate an immune response or cause inflammation of the bladder wall that destroys cancer cells within the bladder. BCG has been used to treat stage 0 and I (superficial) cancer but is used most commonly to prevent the return (recurrence) of superficial bladder cancer. It is most often used after cancer has been removed from the bladder using transurethral resection (TUR) surgery.

BCG is also used in some countries as a vaccine to provide protection against tuberculosis (TB).

BCG is given through a urinary catheter (intravesically) into the bladder.

• Limit your fluid intake for 4 hours before the procedure so you will be able to hold the medication in your bladder during the treatment. Do not drink caffeinated drinks for 4 to 6 hours before and for 2 hours after the procedure.
• Empty your bladder immediately before the procedure. A urinalysis is usually done at this time.
• BCG is given through a urinary catheter. You will be asked not to urinate for 2 hours and to change position every 15 to 20 minutes so the medication washes the entire bladder wall.
• For 6 hours after treatment, wash your genital area after every urination to avoid skin irritation.
• Burning or pain with urination, a sense of needing to urinate often, and urinating small amounts often are common effects after BCG treatment.

BCG is used following TUR surgery for superficial bladder cancer in people who are at medium or high risk for recurrence of cancer. It can also be used following TUR surgery in people who cannot have a cystectomy procedure for bladder cancer, but its usefulness in these cases is limited.

BCG greatly reduces the chance that cancer will progress after TUR surgery for superficial bladder cancer.¹

Side effects from BCG are generally mild and may include:²

• Burning or pain with urination.
• Sense of needing to urinate often (urgency).
• Urinating small amounts often (frequency).
• Fatigue.
• Joint aches.
• Fever of less than 101°F (38°C).
• Skin rash.
• Loss of appetite.
• Nausea or vomiting.
• Inability to hold urine (incontinence).

More severe side effects may include:²

• Hepatitis.
• Inflammation of the lung tissue (pneumonitis).
• For men, epididymitis or orchitis.
• Abscess.
• Contraction of the bladder.
• Obstruction of the ureters.
• Allergic reaction to BCG.
• Low white blood cell count (leukopenia).
• Blood in the urine (hematuria).
• Fever of 101°F (38°C) or higher.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Research continues to determine the most effective strain of BCG and the best dosage schedule for the treatment of bladder cancer. Dosage schedules vary and are determined by your doctor.

If you have major side effects from BCG treatment, you may need additional treatment with antibiotics and corticosteroids.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Citations

1. Sylvester RJ, et al. (2004). Intravesical Bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: A meta-analysis of the published results of randomized clinical trials. Journal of Urology, 168 (5): 1964–1970.

2. Boyd LA (2003). Intravesical Bacillus Calmette-Guerin for treating bladder cancer. Urologic Nursing, 23(3): 189–199.