What Is BCG Treatment for Bladder Cancer?

If you’re diagnosed with early-stage bladder cancer, your doctor might recommend an unusual treatment called Bacillus Calmette-Guerin (BCG) therapy. BCG is used to stop the growth of bladder cancer and keep it from returning.

BCG is actually a vaccine made with a species of weakened mycobacterium, a group of tiny bacteria. The bacteria used in the vaccine is related to the bacteria that causes tuberculosis. But in most people, it doesn’t cause serious disease.

The BCG vaccine is used to protect against tuberculosis, but it can also be used as a therapy against bladder cancer. This vaccine is a type of immunotherapy, which means the goal of the treatment is to get the body’s own immune system to attack and kill the cancer cells. 

BCG treatments are administered as intravesical therapies. This means the vaccine is administered into the bladder itself through a tube called a catheter.

This approach to therapy puts the vaccine and medicines into contact with the lining of the bladder for an extended time. This lets it affect the cells in the bladder and actively fight cancer without impacting other parts of the body.  

This article will review Bacillus Calmette-Guerin therapy, how it works, who can use it, and what to expect when you’re getting this procedure.

Who Can Use BCG?

BCG is a treatment for early-stage bladder cancer that has not yet invaded the muscle of the bladder wall. Called non-muscle invasive bladder cancers (NMIBCs) or in situ bladder cancers, these account for about half of all bladder cancers.

For 2021, it was estimated that about 83,730 new cases of bladder cancer would be diagnosed in the United States, and about 17,200 American bladder cancer patients would die from the disease.

Because of the ongoing shortage of BCG, new guidelines from the American Urological Association aim to make BCG available to those patients with the greatest need. These guidelines prioritize the highest-risk patients to receive full doses of the BCG treatment while suggesting that lower-risk patients can be treated with intravesical chemotherapy instead.

According to a 2020 review in the journal Reviews in Urology, BCG is a very effective therapy for bladder cancer:

• 90% of patients who get BCG see it stop their bladder cancer from getting worse; 10% see the cancer advance into the muscular wall of the bladder.
• 60% of patients do not have their bladder cancer come back after BCG treatment, but 40% of the time cancer comes back within two years. 

What to Expect During BCG Treatment

First, make sure you haven’t had any fluids for four hours before the treatment. Right before you go into the treatment room your doctor or nurse will have you empty your bladder.

You’ll lie on your back, and the medical professional will insert a catheter into your urethra (the hole you pee from) and into your bladder, likely using some local numbing, and use this tube to infuse the treatment. 

Once the treatment is infused, your doctor or nurse will remove the catheter. They’ll have you lie on your back, each side, and your stomach for 15 minutes each. The BCG mycobacteria needs to touch the bladder cancer cells to activate the immune system. You’ll then be free to go but will need to hold off on peeing for another hour.

For at least six hours after your infusion, you’ll need to disinfect your pee to ensure none of the mycobacteria spread to anyone else. Pour an equal amount of bleach into the toilet after you pee and let it sit for 15 minutes before flushing. 

Also, people with a penis who undergo BCG treatment should avoid sex for 48 hours to ensure they don’t pass the mycobacteria to their partners. 

You will likely need multiple BCG treatments. They may be given weekly for a few weeks, then less often for months or years to prevent cancer from coming back.

How to Prepare

To prepare for the BCG treatment, your doctor will likely have you undergo surgery to remove any visible cancer in the bladder. The surgery is called transurethral resection of bladder tumor (TURBT) and is usually done about two weeks before BCG therapy. 

You’ll likely also need a tuberculosis test to make sure you don’t have an active TB infection. 

Side Effects

Side effects of BCG treatment may last two to three days, and can include:

• Swelling of the lymph nodes, which you may feel under the skin 
• Flu-like symptoms, including fatigue, fever, aches, and chills
• Urine that is red or brown in color from bleeding in the bladder or urethra
• Burning in the bladder, pain while peeing, difficulty peeing, frequent peeing 
• Digestive symptoms including upset stomach and vomiting 

When to See a Doctor

There are a few side effects that can be especially dangerous, so make sure to talk to your doctor if you notice that you:

• Have a severe skin rash
• Are wheezing or having difficulty breathing 
• Are finding swallowing to be difficult
• Have a high fever that isn’t lowered with Tylenol (acetaminophen) or other over-the-counter fever reducers

Other Treatments for Bladder Cancer

For many early-stage bladder cancers, BCG is the best option for treatment. Other treatments for bladder cancer include: 

• Surgery to remove the tumor: Early cancers can be removed with TURBT surgery. More advanced cancers may require more extensive surgery, like removal of part or all of the bladder (cystectomy).
• Intravesical chemotherapy: This treats the inside of the bladder with chemotherapy drugs. Chemotherapy drugs commonly used for bladder cancer include Mutamycin (mitomycin), Gemzar (gemcitabine), or Valstar (valrubicin).
• Radiation therapy
• Immunotherapy with a drug such as Opdivo (nivolumab)
• System-wide chemotherapy
• Targeted therapy
• Clinical trials

Summary

BCG treatment is a form of immunotherapy for non-muscle invasive bladder cancer. It is administered into the bladder through a catheter. It then activates the body's immune system to attack the cancer cells.

A Word From Verywell

BCG treatment is well received and safe to take. For many patients, it is effective in slowing cancer progression or stopping cancer from recurring. Ask your doctor if you're a good candidate for this treatment.