BCG treatment for
non-invasive bladder cancer
This information is an extract from the booklet Understanding
non-invasive bladder cancer. Non-invasive bladder cancer is
only in the inner lining of the bladder and has not spread into
the muscle layer of the bladder. You may find the full booklet
helpful. We can send you a free copy – see page 5. We have
included a comment from someone affected by bladder
cancer, which you may find helpful. This has been taken from
our online community (macmillan.org.uk/community).
Contents
• When BCG is used
• How it’s given
• Side effects
BCG is a vaccine used to prevent tuberculosis (TB), but it’s also an effective treatment for some non-invasive bladder
cancers. It’s given directly into the bladder (intravesical).
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).
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BCG treatment for non-invasive bladder cancer
The risk of the cancer coming back depends on different
factors. This includes the stage of the cancer. Non-invasive
bladder cancer is either CIS (see below) or stage Ta or T1 (T stands for tumour). Ta is when the tumour is only in the
inner layer of the bladder lining, while in T1 it has started to
grow into the tissue beneath the bladder lining. The grade of
the cancer (how the cancer cells look under the microscope)
and how many tumours there are, are also taken into account
when considering a person’s risk.
There may be a higher risk 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.
•Ta and T1 cancers that are grade 3 (high-grade).
•T1 cancers that are grade 2 and larger than 3cm (1in) across OR when there are several tumours in the bladder.
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 six-week break, and then once a week for 1–3 weeks.
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.
‘I’ll be having BCG for the next two years
apparently, followed by ops for biopsies, but if it keeps it away then that’s great.’ Page 2 of 5
Deb
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BCG treatment for non-invasive bladder cancer
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. For the first 15
minutes you’ll have to lie on your front, but after that you can
get up and walk around. 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.
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BCG treatment for non-invasive bladder cancer
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.
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BCG treatment for non-invasive bladder cancer
More information and support
Cancer is the toughest fight most of us will ever face. But you
don’t have to go through it alone. The Macmillan team is
with you every step of the way, from the nurses and therapists
helping you through treatment to the campaigners improving
cancer care. We are Macmillan Cancer Support.
To order a copy of Understanding non-invasive bladder
cancer, visit be.macmillan.org.uk or call 0808 808 00 00.
We make every effort to ensure that the information we provide is accurate and up to
date but it should not be relied upon as a substitute for specialist professional advice
tailored to your situation. So far as is permitted by law, Macmillan does not accept
liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. © Macmillan Cancer Support
2013. Registered charity in England and Wales (261017), Scotland (SC039907) and the
Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ
REVISED FEBRUARY 2013
Planned review in 2015
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