Intravesical immunotherapy (BCG)

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

Learn more about:

• How is BCG given?
• Ongoing BCG treatment
• Side effects of BCG
• BCG safety at home
• Podcast: What are immunotherapy and targeted therapy?

How is BCG given?

The combination of BCG and TURBT is the most effective treatment for high-risk non-muscle-invasive bladder cancer. 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. This is usually done as a day procedure in hospital, and each treatment session takes up to two hours.

Your treatment team will tell you what safety measures to follow after you go home. This is because BCG is a vaccine that contains live bacteria, which can harm healthy people.

Ongoing BCG treatment

For most people with high-risk non-muscle invasive bladder cancer, the initial course of six 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. Maintenance treatment can last for 1–3 years, but treatment sessions become much less frequent (e.g. one dose a month).

Treatment schedules can vary so ask your doctor for further details and see BCG safety at home.

Side effects of BCG

Common side effects of BCG include needing to urinate more often; burning or pain when urinating; blood in the urine; a mild fever; and tiredness. These side effects usually last a couple of days after each BCG treatment session.

Less often, the BCG may spread through the body and can affect any organ. If you develop flu-like symptoms, such as fever over 38°C that lasts longer than 72 hours, pain in your joints, a cough, a skin rash, tiredness, or yellow skin (jaundice), contact a nurse or doctor at your treatment centre immediately. A BCG infection can be treated with medicines.

Very rarely, BCG can cause infections in the lungs or other organs in the body months or years after treatment. If you are diagnosed with an infection in the future, it is important to tell the doctor that you had BCG treatment.

BCG safety at home

• For the first six hours after BCG treatment, sit down on the toilet when urinating to avoid splashing. When finished, pour 2 cups of household bleach (or a sachet of sodium hydrochlorite if provided by your treatment team) into the toilet bowl. Wait 15 minutes before flushing with the toilet lid closed.
• If any clothing is splashed with urine, wash separately in bleach and warm water.
• If you use incontinence pads, for a few days after treatment 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. Tie up the bag and put it in your rubbish bin. You may also be able to take the sealed bag back to the hospital or treatment centre for disposal in a biohazard bin.
• For a few days after each treatment, wash your hands extra well after going to the toilet, and wash or shower with soap and water if your skin comes in contact with urine.
• Drink plenty of liquids for 6–8 hours after treatment.
• For a week after each treatment, use barrier contraception (condoms) to protect your partner from any BCG that may be present in your body fluids and to prevent pregnancy.
• Speak to your medical team if you have any questions.

Podcast: What are immunotherapy and targeted therapy?

Listen to more episodes from our podcast for people affected by cancer