Intravesical BCG

BCG is a type of immunotherapy drug and doctors aren’t sure exactly how it works in bladder cancer. It may make the bladder react in a way that triggers the immune system (helps fight infection and disease) to get rid of cancer cells.

When BCG is used

BCG helps prevent the cancer from coming back in the bladder lining, and also reduces the risk of it becoming invasive. It’s usually given when there is a high risk that the cancer will come back and grow into the bladder muscle (become invasive).

This may be in people who have:

• Carcinoma in situ (CIS) - This can’t usually be removed completely with surgery because it’s flat and often widespread in the bladder lining.
• High grade non invasive bladder cancers.

The urologist or cancer specialist will explain why BCG is the most appropriate treatment for you. There needs to be a gap of at least two weeks after you’ve had surgery before BCG treatment can be given.

You’ll usually have your treatment with BCG weekly for six weeks, followed by a check of your bladder.

If the BCG treatment is working well, it can then be given weekly for 1-3 weeks every six months. This is called maintenance therapy and it can be given for up to three years.

Treatment times vary and your doctor will explain what is appropriate in your situation.

How it’s given

Treatment with BCG is given to you in the hospital outpatient department. The treatment takes up to three hours and you can usually go home as soon as it’s finished.

You’re usually asked to limit the amount of liquid you drink before the treatment. This helps to increase the concentration of BCG in your bladder. Plus, drinking too much beforehand can make your bladder feel uncomfortably full. If you normally take water tablets (diuretics), take them later in the day. Your nurse or doctor will give you advice about preparing for your treatment.

When you’re lying down and comfortable, the nurse will put a fine tube (catheter) into your bladder. The BCG is then put directly into your bladder through the catheter. You need to try not to pass urine for two hours afterwards. This can be difficult but the aim is to give the BCG treatment time to work. Sometimes the catheter is left in and clamped to keep the drug in your bladder for the next two hours.

When the treatment is over, you can go to the toilet. If you have a catheter, the BCG is drained into a urine bag before the catheter is removed.

After your treatment, you’ll need to take some precautions for the next six hours. This is because BCG is a live vaccine and other people shouldn’t be exposed to it. The main thing to avoid is urine splashing on the toilet seat or getting urine on your hands. To avoid splashing, men might find it easier to sit down when they’re using the toilet.

After you’ve passed urine, you should put undiluted bleach into the toilet bowl to destroy any vaccine. Leave it for 15 minutes and then flush the toilet with the lid down.

Your nurse or doctor will give you more advice about this.

Side effects

Because BCG goes directly into the bladder, most side effects are linked with the bladder. The most common effects are:

• needing to pass urine often
• pain when you pass urine
• blood in the urine
• flu-like symptoms such as tiredness, general aching and a raised temperature.

These effects should settle down within a day or two. If they don’t get better after this time, contact your doctor. It’s important to drink lots of fluid, which will help flush the drug out of your bladder and reduce some of the side effects. Taking painkillers will also help.

Rare side effects can include a continuing high temperature (fever), pain in your joints and a cough. If you have any of these symptoms, or feel generally unwell, contact your doctor immediately. It could be a sign of a more serious infection due to the BCG that needs urgent treatment. If this happens, you’ll be treated with antibiotic drugs used to treat TB.

Protecting your partner

Men should use a condom if they have sex during the first week after having BCG treatment. If you’re a woman having the treatment, your partner should use a condom during this time. This protects your partner from any vaccine that may be present in semen or vaginal fluid.

Contraception

It’s not known how BCG may affect an unborn baby, so it’s not advisable to become pregnant or father a child while having it.

It’s important to use effective contraception during treatment and for six weeks afterwards. You can discuss this with your doctor or specialist nurse.