Bacillus Calmette-Guerin (BCG) is an intravesical immunotherapy that uses the bacteria of Mycobacterium bovis (bovine TB) to kill bladder cancer cells. BCG is currently the most effective treatment for bladder cancers that return in patients with an aggressive diagnosis.
Who is a Candidate?
Patients with bladder cancer may develop non-muscle invasive bladder cancer, or NMIBC. Patients with NMIBC have a tumor that has not yet reached the true muscle layer of the bladder. At this stage, it is possible to treat the condition without removing the patient’s bladder.
Before a patient can receive BCG instillations, the cancerous cells must be removed through a procedure called the transurethral resection of the tumor (TURBT). Multiple surgeries may be necessary if the tumor is high grade and has penetrated multiple layers of the bladder.
BCG is instilled into the bladder using a catheter to help stimulate the patient’s immune system to destroy the cancerous cells in the bladder. Because BCG is instilled locally, the bacteria is unable to reach other cells in the body.
Patients may be good candidates for BCG instillations depending on the size of the tumor, the location of the tumor, the grade of the tumor, if the patient has previously had a tumor in the bladder, the length of time it took for the tumor to regrow and if the bladder cancer is a pure urothelial cancer. Patients with intermediate- and high-risk NMIBC will likely be candidates for BCG instillations.
How to Prepare for BCG Instillations
Prior to treatment, patients should restrict fluid intact, caffeinated beverages and the use of diuretics. In addition, patients should avoid urinating for one to two hours after the procedure.
For six hours after the treatment, patients should:
- Sit while relieving themselves in order to avoid urine splashing
- Avoid using public toilets
- Add two cups undiluted bleach to the toilet, close the lid, wait 15-20 minutes and then flush the toilet, after every time they urinate
- Increase fluid intake to dilute the urine
- Wear a condom if they are sexually active throughout the entire treatment course
- Immediately wash their clothes in the washer (and avoid washing with other clothes) if they have urinary incontinence
- Pour bleach on their incontinence pad (if they are wearing one), allow the bleach to soak in, place into a plastic bag and discard
Potential Side Effects or Complications
After receiving BCG instillations, patients may experience the following common side effects that do not require medical attention:
- Small amount of blood in the urine
- Fever (99-100℉)
- Feeling tired
- Desire to frequently and urgently urinate
- Burning sensation while urinating
- Muscle or joint aches
Other less common and rare side effects that may require medical attention include:
- Skin rash/ eruptions
- Fever higher than 101.3°F
- Pneumonitis
- Nausea/vomiting/anorexia (or lack appetite)
- Urinary incontinence
- Blood in the urine and an inability to pass urine due to clots
- Urinary tract infection
- Ureteral obstruction
- Abscess formation
- Bladder spasms
- Bladder contracture/necrosis (cell death)
- BCG sepsis
- Neutropenia (low count of white blood cells that fight off infection)
- Inflammation in testicle/scrotal region
- Tissue necrosis with leakage of fluid
- Hepatitis
