Bacillus Calmette-Guérin (BCG) therapy is an intravesical immunotherapy that treats high-grade non-muscle invasive bladder cancer (NMIBC) by triggering the immune system to destroy remaining cancer cells after tumour-removal surgery. It is the leading treatment option for early-stage bladder cancer. Doctors deliver BCG directly into the bladder through a catheter, where it remains for one to two hours before being expelled through urination. Treatment typically begins with an induction phase of once-weekly instillations for six weeks, often followed by a maintenance phase of shorter, periodic courses to help reduce the risk of recurrence. BCG treatment targets bladder cancer cells while minimizing harm to healthy tissue, making it a key part of a comprehensive bladder cancer treatment plan.
Bacillus Calmette-Guérin (BCG) Therapy for Bladder Cancer
What is Bacillus Calmette-Guérin (BCG) treatment?
Bacillus Calmette-Guérin (BCG) is an intravesical immunotherapy used for bladder cancer and is administered directly into the bladder through the urethra. It is a weakened form of the tuberculosis vaccine that stimulates the immune system to target and destroy cancer cells. BCG treatment is a form of immunotherapy, with localized anticancer effects and primarily local side effects. It is often used in conjunction with other treatments as part of a comprehensive strategy to eradicate cancer tumours in the bladder.
How is BCG administered and how does it work?
BCG treatment involves weekly instillations for six weeks, typically starting a few weeks after Transurethral Resection of Bladder Tumour (TURBT) surgery. Delivered intravesically (directly into the bladder), the solution needs to be in contact with the bladder lining to be effective, requiring patients to change positions periodically during treatment. After instillation, patients hold the solution in their bladder for approximately two hours to maximize its efficacy in targeting bladder cancer cells.
This initial six-week course is known as the induction phase. Many patients continue afterward with a maintenance phase; shorter, periodic courses of BCG designed to help reduce the risk of the cancer returning. The exact maintenance schedule is determined by a urologist based on individual risk factors and how the cancer responds to induction treatment.
When is BCG therapy used?
BCG therapy is primarily used as a bladder cancer treatment to treat high grade NMIBC and carcinoma in situ (CIS) to reduce the risk of recurrence or spreading. It is administered after all visible tumours are removed through a TURBT and the bladder has healed. Due to the live bacteria used in BCG treatment, precautions are taken to minimize the risk of contamination during disposal.
What are the benefits of BCG?
BCG remains one of the most established immunotherapy options for treating high-grade NMIBC, and it offers several advantages including:
- Its non-invasive nature
- Bladder saving potential
- It may not require simultaneous use of other medications to be effective
- Its ability to target cancer cells while sparing healthy ones
BCG therapy offers significant advantages in bladder cancer treatment, providing a localized approach with minimal impact on surrounding tissues, making it a valuable tool in the fight against cancer.
What are the side effects of BCG?
Side effects of BCG treatment include:
- Burning sensation during urination
- An increased frequency or urgency to urinate
- Fatigue
- Mild fever, achiness, and nausea
Severe reactions are rare but can include pain, inflammation, and bleeding. If any of these symptoms occur, be sure to contact a medical professional immediately.
Please note that the cumulative nature of BCG’s side effects often results in an escalation of symptoms as the treatment advances.
Tips for BCG Treatment
These practical steps can help make each stage of BCG treatment more manageable and reduce risks to both you and those around you:
- To manage leakage concerns after BCG treatment, consider using an incontinence pad.
- To reduce infection risks, shower after urinating for the first-time post-treatment and wash clothes in hot water.
- Frequent urination helps prevent bladder issues. As BCG can be infectious, sit while urinating and double-flush the toilet to safely dispose of BCG in the urine. Alternatively, add 1-2 cups of household bleach to the toilet and let it sit for 15 minutes before flushing.
- If you have dental appointments involving implants or gum surgery that may involve bleeding sites, consider delaying your dental work to avoid potential BCG bacteremia and secondary infections in the healing tissue. Speak with your urologist before any dentistry procedures.
Navigating Bladder Cancer and BCG Treatment with Bladder Cancer Canada
Bladder Cancer Canada is the first and only patient advocacy organization in Canada dedicated to bladder cancer issues. Facing bladder cancer is undoubtedly a challenging journey, but with the support of the Bladder Cancer Canada community, you can find the strength and knowledge to navigate it more confidently.
Whether you’re newly diagnosed, currently undergoing BCG treatment, or supporting a loved one through it, you don’t have to navigate bladder cancer alone. We connect patients with peer support, educational resources, and a national community built specifically around bladder cancer.
Contact us for support and guidance!