What to Expect: BCG Treatment

Starting BCG Treatments: What to Expect Before, During, and After

Bacillus Calmette-Guérin (BCG) is a type of immunotherapy used to treat bladder cancer. BCG is placed in the bladder through a catheter. This triggers the body’s immune system to stop or slow down the growth of cancer cells.1,2

Currently, BCG is the most common treatment for early-stage bladder cancer. In some cases, BCG is given after bladder surgery to remove any visible cancer. The BCG treatment is generally given weekly for 6 weeks.1

Before the procedure

Before beginning BCG treatment, tell your doctor about all the medicines you are taking. Some drugs can interfere with the immune response caused by the BCG treatment.3

You will likely be asked to stop drinking fluids or taking diuretics about 4 hours before the procedure. Right before the procedure, you may be asked to pee to make sure your bladder is empty. Your doctor may also provide other guidelines for you to follow.1

During the procedure

First, local anesthesia is used to numb the area. Then, the doctor inserts the catheter into the canal that leads to your bladder (urethra). A catheter is a tube that allows liquids to enter or exit the bladder.1

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The liquid BCG solution enters the bladder through the catheter. At this point, your doctor will clamp or remove the catheter. You will be asked to lie on your back, stomach, and each side for 15 minutes. This will make sure that the liquid BCG comes in contact with all the surfaces of the bladder. You may be asked to avoid peeing for at least one more hour.1

After the procedure

BCG is a live vaccine, which means it contains a weakened form of bacteria. You should follow certain safety measures to keep others from getting infected with the bacteria.1

BCG can remain in the urine after the treatment. So, bleach the toilet after each time you pee for the first 6 hours after the treatment. Let 2 cups of bleach sit in the toilet for 15 to 20 minutes before flushing.1

When peeing, sit down on the toilet to avoid splashing. Immediately bleach anything that comes in contact with the urine for a few days after treatment. Wash your hands thoroughly after using the toilet.1

Also, you should not have sex for a few days after each BCG treatment. During the course of the treatment, use a condom during sex to avoid spreading the bacteria.1,2

BCG as maintenance therapy

After your first course of BCG treatment, it may be used again as maintenance therapy. Maintenance therapy is used to prevent bladder cancer from recurring. It has also been shown to reduce the progression of bladder cancer.4

Maintenance therapy is recommended for at least 1 year after the first treatment. But this time frame and how often you have the treatment can vary. Maintenance therapy may be given 3, 6, and 12 months after the first dose. These additional doses may continue for 1 to 3 years.4

Side effects of BCG

After BCG therapy, you may develop some symptoms. Most of these side effects go away within 2 days. Talk to your doctor if you are still experiencing symptoms 48 hours after the treatment.1

Common side effects of BCG include:1,2,4

  1. A small amount of blood in your pee
  2. Mild fever
  3. Tiredness
  4. A burning sensation or pain when you pee
  5. Needing to pee more often
  6. Body aches

Less commonly, BCG can cause more serious side effects or an infection. If you experience any of the following symptoms, contact your doctor right away:1-3

  • Fever above 100 degrees Fahrenheit
  • Skin rash
  • Night sweats
  • Flu-like symptoms

After BCG therapy, there is a chance the cancer will come back (recur). Your doctor will discuss a plan to monitor you for recurrence. This may include regular visits to the doctor over several years. These visits may include different types of tests that are used to detect bladder cancer.4

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