BCG treatment for non-invasive bladder cancer

BCG is an immunotherapy drug used to treat some non-invasive bladder cancers. It is given at least two weeks after surgery. Your doctor or nurse will give the drug directly into your bladder (intravesical treatment).

You usually have BCG treatment once a week for six weeks, followed by a six-week break. If it is working well, you may have more treatment. Your doctor will explain what is best in your situation.

Your nurse or doctor will tell you how to prepare for treatment. Treatment takes up to three hours in the outpatient department but you can usually go home straight after.

Your nurse will talk to you about precautions to take after treatment. This is to protect other people as BCG is a live vaccine.

You may have some side effects from BCG treatment such as going to the toilet more often or having pain or blood when passing urine. These should settle in a day or two. Tell your doctor or nurse if they don’t get better or you have other symptoms such as fever, joint pains or a cough.

BCG treatment

BCG is a type of immunotherapy drug used to treat some non-invasive bladder cancers. It is given directly into the bladder (intravesical). Most people know BCG as a vaccine used to prevent tuberculosis (TB). BCG may make the bladder react in a way that triggers the immune system to get rid of cancer cells.

When BCG is used

BCG helps prevent the cancer from coming back in the bladder lining. It also reduces the risk of the cancer becoming invasive. Doctors usually advise it if you have high-risk bladder cancer or sometimes if you have an intermediate-risk bladder tumour.

After you’ve had surgery, there needs to be a gap of at least two weeks before you can have BCG treatment. This is to let the bladder heal after surgery.

You usually have BCG treatment once a week for six weeks.

This is followed by a six-week break. After the break you may have BCG once a week for one to three weeks. If the BCG is working well, you may be offered maintenance treatment.

Treatment times vary. Your doctor will explain what is best for you.

Recently there have been some difficulties with the availability of BCG. Your urology doctor or specialist nurse can explain if this is likely to affect your treatment.

How it is given

You have treatment with BCG in the hospital outpatient department. It takes up to three hours. You can usually go home as soon as it is finished.

You are usually asked to limit the amount of liquid you drink before treatment. This helps to increase the concentration of BCG in your bladder. And drinking too much beforehand can make your bladder feel uncomfortably full. If you normally take water tablets (diuretics), take them later in the day. Your nurse or doctor will give you advice about preparing for your treatment.

When you’re lying down, the nurse passes a tube (catheter) into your bladder. The BCG is then put directly into your bladder through the catheter. You can get up and walk around after that.

Try not to pass urine for two hours afterwards. This can be difficult, but it gives the BCG treatment time to work. Sometimes the nurse leaves the catheter in and clamps it for the two hours. This is to keep the drug in your bladder.

When the treatment is over, you can go to the toilet. If you have a catheter, the nurse removes the clamp and the BCG is drained into a urine bag. The nurse can then remove the catheter.

After treatment, you need to take some precautions for the next six hours. This is because BCG is a live vaccine and other people shouldn’t be exposed to it.

You will be asked to:

  • avoid urine splashing on the toilet seat – you should sit down to pass urine
  • avoid getting urine on your hands
  • after passing urine, put undiluted bleach into the toilet bowl to destroy any vaccine – leave it for 15 minutes and then flush the toilet with the lid down
  • wash your hands carefully after using the toilet.

Your nurse will explain what you need to do after treatment.

Side effects of BCG

The most common effects of BCG are:

  • needing to pass urine often
  • pain when you pass urine
  • blood in the urine
  • flu-like symptoms such as tiredness, general aching and a raised temperature.

These effects should settle down in a day or two. If they don’t get better after this time, contact your doctor. You should drink lots of fluids. Try to drink about two to three litres (three and a half to five pints) per day. This will help flush the drug out of your bladder and reduce some of the side effects. Taking painkillers will also help.

Rare side effects can include a continuing high temperature (fever), pain in your joints and a cough. If you have any of these symptoms or feel generally unwell, contact your doctor straight away. It could be a sign of a more serious infection due to BCG that needs urgent treatment. If this happens, you’ll be treated with antibiotic drugs used to treat tuberculosis (TB).

Sex after treatment

Men should use a condom if they have sex in the week after having BCG treatment. If you’re a woman having the treatment, your partner should use a condom during this time. This protects your partner from any vaccine that may be present in semen or vaginal fluid.

Doctors don’t yet know how BCG may affect an unborn baby. They will recommend you do not become pregnant or father a child while having it. You should use effective contraception during treatment. You can discuss this with your doctor or specialist nurse.