What is BCG treatment?

  • BCG is a live vaccine used to vaccinate against TB (tuberculosis) but is also used to treat bladder cancer
  • It can also be put into the bladder through a catheter to help reduce the risk of the cancer coming back or recurring.
  • When it is put into your bladder it causes inflammation. This inflammation destroys cancerous cells. The aim of this treatment is to stop the cancer growing and spreading.
  • BCG treatment is normally given once a week for 6 weeks.

Are there any reasons why I should not have BCG?

  • If you have a urinary tract infection (UTI).
  • If your TURBT (the initial operation to remove the cancer from your bladder) was done less than 14 days before the date of your BCG treatment.
  • If you are taking immunosuppresive medication or are immunocompromised
  • If you have a bleeding disorder
  • If you have active TB and are receiving treatment
  • If you are breast feeding.
  • If you are pregnant or trying to conceive you should discuss this with your doctor before any treatment is started.

Is there anything I need to do before my treatment?

  • You should not drink fluids for 4 hours before treatment. One glass of water may be taken with breakfast. You can eat normally. By drinking less your kidneys will produce less urine. This will help prevent the BCG being diluted and will also make it easier for you to hold the BCG in the bladder.
  • If you normally take water tablets (diuretics) either take them after your BCG treatment is completed or at least 6 hours before your treatment. This will reduce the amount of urine produced and will enable you to hold the BCG in the bladder.

What happens during treatment?

  • You will be asked to pass urine so that your bladder is empty.
  • A catheter (hollow tube) will be passed into the bladder through the water pipe (urethra) to drain any remaining urine. BCG, which is mixed in a little water, is put into the bladder through the catheter.
  • The catheter will then be removed. In some cases the catheter may be left in the bladder whilst you are having your treatment. If this is so, the catheter will be clamped to keep the BCG in the bladder.
  • You will be asked not to pass urine for the next 2 hours. It is during this time that the treatment is working to destroy the cancer cells.
  • You can walk about when the BCG is in your bladder, this will help the BCG to work on the whole of the bladder. If you cannot walk about you will be asked to lie down and to turn from back to side to front to side every 15 minutes to ensure the BCG covers the whole bladder.

How long will the treatment take?

  • You will need to keep the BCG in the bladder for 1-2 hours. After this time you will be able to go home. You should feel well enough to drive yourself home after the treatment.
  • If you are elderly or infirm, you should arrange for a friend or relative to collect you.

What to do after your treatment.

  • When the BCG has been in the bladder for 2 hours you will be asked to pass urine into the toilet (men should sit rather than stand to pass urine to prevent splashing). If the catheter was left in the bladder during your treatment, the BCG will be drained back into a bag before the catheter is removed. If you would like something to drink you can now do so.
  • Sex – you should abstain from intercourse/oral sex for 2-3 days after each treatment. The use of condoms thereafter is advised and should continue to be used for several weeks after your treatment has been completed.
  • The effects on pregnancy are unknown. If you are planning to have children you should discuss this with your doctor as female patients of child bearing age are advised to use birth control during treatments and to wait at least 2 years before conceiving, longer if on maintenance treatment
  • Breast feeding is not advised when having BCG treatment
  • You will be able to carry out your normal activities after treatment. There are no restrictions on driving, work etc.

Are there any special precautions I should take at home?

  • Wash hands/genital area with soap and water each time after passing urine. This should be done for 6 hours after treatment, After passing urine, pour 2 cups of undiluted household bleach into the toilet and let it stand for 15 minutes before flushing. Ensure no one uses the toilet during this time or before flushing. All urine passed within 6 hours from the initial time your treatment was given, should be treated as above.

Are there any possible side effects from the treatment?

  • 9 out of 10 people having BCG treatment will develop some side effects; these usually begin within 3-4 hours after treatment and may last 1-3 days.

Common side effects include:

  • Pain and/or burning when passing urine
  • Blood in your urine
  • Needing to pass urine frequently (bladder irritation, cystitis)
  • Fever, flu like illness or generally feeling unwell
  • Drinking 2 litres of fluid, unless advised otherwise, and avoiding tea/coffee for 24hours after treatment will help flush any remaining drug out of the bladder and ease the above symptoms.

The above are all due to the effect of the treatment on the bladder and are nothing to worry about. These symptoms should stop after 1-2 days.

Contact your GP/Nurse immediately if:

  • Symptoms persist for more than 2-3 days
  • Urine is cloudy/offensive smelling
  • Temperature >38°C,
  • Vomiting
  • Joint pain
  • Skin rash
  • Cough

See a doctor or attend A&E immediately if you develop:

  • Shortness of breath
  • Difficulty breathing
  • Facial swelling

You need to inform them that you have had BCG treatment.

What follow up will I be given?

  • After you have completed your treatment you will be booked to have a repeat cystoscopy (telescopic inspection of the bladder) in 4-6 weeks time to see if the treatment has worked. This is normally done using a general anaesthetic (you will be put to sleep) unless your doctor tells you otherwise. Further biopsies may be taken at this time.