Bacillus Calmette-Guerin (BCG) for bladder cancer

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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 cancer but is used most commonly to prevent the return (recurrence) of noninvasive 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 medicine 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 medicine washes the entire bladder wall.
• For 6 hours after treatment, wash your genital area after every urination to avoid skin irritation.
• Treatment is usually given once a week for 6 weeks. After this, you may be treated again every 3 to 6 months over the next 2 years.
• 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 noninvasive 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 noninvasive bladder cancer.¹

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

• Changes in urination or inability to hold urine (incontinence).
• Fatigue, joint aches, skin rash, or fever of less than 101°F (38°C).
• Loss of appetite, nausea, or vomiting.

More severe side effects may include:²

• Hepatitis or abscess.
• Inflammation of the lung tissue (pneumonitis).
• For men, inflammation and infection of the prostate, testicles, or epididymis.
• Contraction of the bladder or obstruction of the ureters.
• Allergic reaction to BCG or disseminated tuberculosis.
• Low white blood cell count (leukopenia) or blood in the urine (hematuria).

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 more treatment with antibiotics and corticosteroids.

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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.