BCG Treatments for Bladder Cancer
WHAT IS BCG?
BCG, also known as Bacillus Calmette-Guerin, is a medication instilled
into the bladder to help treat and prevent recurrent bladder cancer. BCG
contains a live, weakened bacteria (a strain of the tuberculosis vaccine)
that stimulates the immune system to kill cancer cells in the bladder. BCG
uses the body’s natural ability to fight the bladder cancer. BCG is most
often used after the tumor is removed during surgery.
TB TEST RECOMMENDED PRIOR TO BCG.
The use of BCG may cause a falsely positive tuberculin reaction
sensitivity. We therefore feel it is advisable to test to determine the true
tuberculin reactivity before treatment. We will contact your primary care
provider to let them know that you need to have this done. They will
contact you to set it up. This should be completed and results faxed to our
office prior to your first BCG instillation appt.
WHO IS A CANDIDATE FOR BCG?
BCG is typically used on those who have bladder cancer that is high grade, occurs in more than one area in the
bladder, is flat against the bladder wall (carcinoma in situ) or comes back after treatment.
Your first set of BCG treatments will start approximately 4-6 weeks after removal of your tumor. This allows
ample time for the bladder to heal. Your first, or induction, course of BCG will consist of six treatments, each 1
week apart. You will then receive maintenance doses of BCG, which consist of 3 weekly treatments. You will
get these at 3, 6, 12, 18, 24, 30, and 36 months after your induction BCG. In between these treatments, your
doctor will need to inspect the inside of your bladder with a small camera called a cystoscope. This is typically
done in our office. This will be done every 3 months for the first 2 years, every 6 months during the 3rd year
after your tumor removal, and then annually. If, during this time, you have a recurrence of your bladder tumor,
the cycle will start over again from the beginning.
PRIOR TO YOUR BCG TREATMENT:
Do not drink any fluids for 4 hours prior to your appointment. Avoid caffeine for 4 hours prior to your
appointment. You will need to retain the BCG in your bladder for 2 hours. Be sure to fill out your pre-treatment
questionnaire as completely as possible. Inform the nurse of doctor if you have felt feverish, had chills,
increased fatigue, other flu-like symptoms or had bright red blood in your urine prior to your treatment.
HOW IS BCG GIVEN?
BCG is given in your urologist’s office. A small catheter is placed into the bladder, your bladder is drained, and
the BCG solution is given through the catheter. The catheter is then removed. The BCG solution then stays in
the bladder for a total of 2 hours.
WHAT IS EXPECTED AFTER BCG?
After you receive this medication, you will need to lie for 15 minutes each on your back, stomach, and then
each side for a total of 1 hour. After the first hour, you will be able to sit up, but you should try to keep the
medicine in your bladder for another hour. At the end of 2 hours, you can empty your bladder. If you cannot
hold the medicine in your bladder for the full 2 hours, you should urinate sooner. Tell your urologist if you are
not able to keep the medication in your bladder for 2 hours. Be sure to drink plenty of liquid after you urinate to
flush out the bladder.
Once outside the body, the BCG fluid may be unsafe for you and others to touch. With proper use of simple
precautions, the bacteria are not likely to be passed along to other people. After treatment, there are some safety
steps you must follow:
 For at least six hours after the BCG treatment, drink plenty of fluids to wash out your bladder.
 Sit down to urinate to avoid splashing. Touching the medicine outside the bladder may be unsafe for
you and others.
 After you urinate, add two (2) cups of chlorine bleach to the toilet, close the lid, and wait 15 minutes
before flushing.
 Wash your genital area and your hands carefully with antibacterial soap and water each time you
urinate.
 For six hours after the treatment, follow the four steps given above each time you urinate.
SIDE EFFECTS OF BCG:
Most of the reactions after receiving BCG are related to irritation of the bladder. However, on occasion, people
may have a reaction that affects the whole body. Reactions usually begin 4 to 6 hours after treatment and may
last 24 to 72 hours.
It is common to experience urgency, frequency and mild burning with urination after receiving BCG. Some
patients notice blood in the urine for a few hours also. Some people also experience flu-like symptoms.
It is important to inform your urologist if you have unusual symptoms such as fever, chills, increased fatigue,
nausea or vomiting, headaches or dizziness. Also report joint pain, cough or rash.
On occasion, the BCG needs to be diluted to a lesser strength because of these reactions. Also, some people
may require a medication to take before getting the BCG to help reduce the symptoms. For this reason, it is
important to inform your urologist if you have the above symptoms.
Some patients want to know if it is safe to have sexual intercourse after BCG therapy. It appears to be safe, but
the use of a condom is strongly recommended for at least 48 hours after the BCG solution is first passed from
the bladder.
WHAT SHOULD I TELL MY HEALTH CARE PROVIDER BEFORE STARTING BCG
TREATMENT?
Your urologist will review your health history and medications prior to starting BCG, however, it is important
to tell your health care provider if you have ever had:
 An organ transplant
 HIV or AIDS
 Tuberculosis (Tb)
 An allergic reaction to rubber latex
Also, tell your urologist if you are taking chemotherapy drugs, antibiotics or prescription arthritis medication
such as methotrexate or infliximab (Remicade). Also, tell him if you are taking cortisone, hydrocortisone,
prednisone or immunosuppressants such as cyclophosphamide (Cytoxan, Neosar) and cyclosporine
(Sandimmune, Neoral), or if you are undergoing radiation.
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You can reach our office at 920-739-3537 or 1-800-529-9908. If it is after normal business hours there
will be someone on call that can help you.
2500 E. Capitol Dr. Ste. 2600
Appleton, WI 54911
(920) 739-3537 / 800-529-9908
Illustrations used with permission: http://www.merckmedicus.com/medical-media-library/Staging-system-for-bladder-cancer