Immunotherapy: BCG treatment

Immunotherapy uses substances that encourage the body’s own natural defences (immune system) to fight disease. Bacillus Calmette-Guérin (BCG) is a vaccine that was originally used to treat tuberculosis. It can also stimulate a person’s immune system to stop or delay bladder cancer coming back or becoming invasive.

The combination of BCG and TURBT is the most effective treatment for many non-muscle-invasive bladder cancers, including carcinoma in situ, high-grade tumours, and those that have grown into the lamina propria.

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How is BCG given?

BCG is given once a week for six weeks, starting 2–4 weeks after TURBT surgery. It is put directly into the bladder through a catheter. You may be asked to change position every 15 minutes so the vaccine washes over the entire bladder. Each treatment session takes up to two hours.

For most people, the initial course of weekly BCG treatments is followed by what is known as maintenance BCG. Maintenance treatment with BCG reduces the risk of the disease coming back or spreading. This treatment can last 1–3 years, but the treatments are given much less frequently, often monthly. Ask your doctor for further details.

BCG and safety at home

After BCG treatment, your medical team will ask you to follow these safety measures. This is because BCG is a vaccine that contains live bacteria, which can harm healthy people.

  • For the first six hours after BCG treatment, sit down on the toilet when urinating to avoid splashing.
  • Pour a small amount of household bleach into the toilet bowl and leave for 15 minutes before flushing and wiping the toilet seat.
  • Wash your hands thoroughly after going to the toilet.
  • If you are wearing incontinence pads in case of leakage, take care when disposing of them. Pour bleach on the used pad, allow it to soak in, then place the pad in a plastic bag, seal the bag and put it in your rubbish bin. You may be able to take it back to the hospital or treatment centre for disposal in a biohazard bin.
  • If any clothing is splashed with urine, wash separately in bleach and warm water.
  • Wash or shower if your skin comes in contact with urine for the first few days after treatment.
  • Speak to your doctor or nurse if you have questions about these safety measures.

Side effects of BCG treatment

Common side effects of BCG include:

  • needing to urinate more often
  • burning or pain when you pass urine
  • blood in your urine
  • mild fever and tiredness for a couple of days.

Let your doctor know of any other medicines or complementary therapies you are having, as they may interfere with how well the bladder cancer responds to BCG. For example, the drug warfarin (a blood thinner) is known to interact with BCG.

If you develop flu-like symptoms, such as fever over 38oC that lasts longer than 72 hours, pain in your joints, a cough, a skin rash, or severe tiredness, or your skin becomes yellow (jaundice), it is important to contact your nurse or doctor immediately. This may mean a BCG infection has spread throughout the body. However, this is an uncommon reaction.

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This information was last reviewed in February 2018
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