Bacillus Calmette-Guérin (BCG) is a live vaccine, which is also used to vaccinate against TB (tuberculosis)
BCG is given to treat bladder cancer and helps prevent the cancer from recurring
When it is put into your bladder it causes inflammation. This inflammation destroys tumors and cancerous cells, therefore helping to stop the cancer from growing and spreading.
Is there any reason why I should not have BCG?
If you have an active urinary tract infection;
If your TURBT (the operation to remove the tumors from your bladder) was done less than 14 days ago
If you are immunosuppressed because of medication you are taking
You should not receive a ‘live’ vaccine for 4 weeks before or after receiving a dose of BCG
Is there anything I need to do before my treatment?
You should limit what you drink (one hot drink/one glass of water) for four hours before treatment. By reducing your fluid intake it will help to increase the concentration of BCG in the bladder and allow you to keep the BCG in the bladder for the necessary amount of time;
If you normally take diuretics (water tablets), take them after your
BCG instillation is completed rather than first thing in the morning.
This will help in a similar way to reducing your fluid intake.
How long will the treatment take?
You will need to keep the BCG in the bladder for two hours. After this time you will be able to go home. You should feel well enough to drive yourself home after the treatment, but on the first occasion you may want to ask for a friend or relative to collect you, just in case.
What happens during treatment?
You will be asked to pass urine so that your bladder is empty
A catheter (small rubber tube) will be passed into the bladder through the urethra (tube through which you pass urine). The BCG, which is mixed in a little water, is put into the bladder through the catheter
You will be asked to empty your bladder into the toilet after the two hour period is complete
You will need to let the staff know so that undiluted bleach can be poured into the toilet and left to stand for 15 minutes before flushing
Are there any possible side effects from the treatment?
You will not lose your hair or suffer sickness (this is a common worry).
The treatment you are having is called immunotherapy and is not the same as chemotherapy. Because the drug goes directly into the bladder, the common side effects are on the bladder itself.
Pain and/or burning when passing urine
Blood in your urine
Needing to pass urine frequently (bladder irritation, cystitis)
Drinking good amounts of fluids for 24 hours after treatment will help to flush any remaining drug out of the bladder and may help ease the above symptoms. The above are all due to the effect of the treatment on the bladder and should stop after 1-2 days.
Are there any special precautions I should take when I get home?
You will be able to carry out your normal activities after treatment and there are no restrictions on driving, returning to work etc
Men should sit, rather than stand, to pass urine. This will help to prevent splashing; For the six hours following treatment pour 2 cups of undiluted household bleach into the toilet after urine is passed and let it stand for 15 minutes before flushing
Sexual intercourse - you should use a condom for 24 hrs after your treatment
What follow-up care will I be given?
A normal treatment course of BCG is one dose a week for a six week period
Your doctor will explain if there is any reason to follow an alternative treatment course
An appointment will be made for you to have a cystoscopy 8-12 weeks after your BCG course has been completed. This involves passing a telescope into the bladder to see if any cancer remains
It is normally done using a general anesthetic. Further biopsies may be taken at this time
Will I need any further treatment?
After your cystoscopy your doctor may decide to continue with maintenance therapy to stop the bladder cancer from recurring.
This involves having BCG treatment once a week for three weeks.
This will be given three, six, 12 and 18 months after your first course of BCG treatment. This decision may be deferred until any biopsies taken at cystoscopy have been reviewed.
To avoid a delay in waiting for another outpatient appointment, it is usual practice to inform patients of these decisions by telephone.
If you do not wish to be informed in this way please let us know when you come in for your cystoscopy.
