What is BCG Treatment for Bladder Cancer?

Bacillus Calmette-Guérin, also known as BCG, is a drug commonly used to treat early-stage bladder cancer. It is a type of immunotherapy, meaning it “uses the body’s own immune system to kill the cancer cells,” said Sam S. Chang, MD, Chief Surgical Officer at the Vanderbilt Ingram Cancer Center in Nashville, Tennessee.

BCG is made from a strain of bacteria called Mycobacterium bovis that has been modified to trigger an immune response in the body without causing illness, similar to the way a vaccine works. It is instilled directly into the bladder through a catheter.

“Once in the body, BCG activates T cells, natural killer cells, macrophages, all of those things that see the cancer cells as foreign and then try to eradicate it,” Dr. Chang said.

Who is BCG therapy for?

BCG immunotherapy is considered “first-line therapy for patients with non-invasive bladder cancer,” said Dr. Chang. This means for patients found to have no invasion of cancer cells into the bladder wall. This is also known as Non-muscle invasive bladder cancer.

Because BCG works by harnessing the power of the immune system, it is usually not recommended for patients who are immunocompromised. BCG is not effective in situations where the cancer has spread (metastasized) to other parts of the body.

The treatment itself is typically done as an outpatient procedure and takes 1-2 hours to complete. After you’ve urinated to empty all the urine from your bladder, a catheter is passed through the urethra and into to bladder, and the BCG solution is infused into the bladder. Once the solution is in the bladder, the catheter is removed. You will be asked to lie down in different positions so that the solution can come into contact with all parts of the bladder. Once you leave your appointment, you will be asked to wait at least two hours before urinating and expelling the solution.

Typically, treatment will need to be repeated at different weekly, monthly, or yearly intervals, depending on your doctor’s recommendation.

What side effects can be expected after BCG treatment?

The most common side effects occur in the 24 hours following infusion, noted Dr. Chang, and are related to lower urinary tract signs. These can include an increased need to urinate, blood in the urine, and a burning sensation when urinating.

Rarely, flu-like symptoms can occur if some of the BCG is absorbed into the blood stream. Consult your doctor right away if you have symptoms such as fever or chills following your BCG treatment.

How effective is BCG therapy?

BCG immunotherapy is often very effective when used early on, but response will depend on the type of cancer that is being treated. For patients with carcinoma in situ, it is effective in 60% to 80% of cases, according to Dr. Chang.

There is a risk that bladder cancer can recur, even after successful treatment with BCG. For this reason, your doctor will likely recommend close monitoring at monthly or yearly intervals.