If you've been diagnosed with early-stage bladder cancer and your doctor prescribes Bacillus Calmette-Guérin (BCG) treatment, you likely googled "What is BCG treatment for bladder cancer," which led to even more questions.

We've asked one of our physician assistants, Victoria Webber, to answer some of these common questions, including what BCG treatment is, how it's administered, its effectiveness, and potential side effects.

As with all content on our blog, the following is educational, not medical advice. Always consult your medical provider regarding your unique healthcare needs. 

What is early-stage bladder cancer?

VICTORIA WEBBER: "Early stage" bladder cancer typically refers to cancer of the bladder lining that has not yet invaded the muscle of the bladder (non-muscle invasive bladder cancer).

What types of therapies are used to treat early-stage bladder cancer?

VICTORIA WEBBER: When a bladder tumor is found on cystoscopy, the patient will typically undergo surgical removal of the tumor in the operating room. (A cystoscopy is a procedure that allows your urologist to see the inside of your bladder and urethra via a cystoscope, which is a thin, flexible tube with a camera.) The goal of this surgery is to both remove the cancer (treatment) and to determine the stage of the cancer.

Patients with non-muscle invasive bladder cancer will require close monitoring with routine cystoscopies. They may also need to undergo intravesical therapy (medication instilled in the bladder through a urethral catheter) with either a chemotherapy agent or BCG (immunotherapy).

Let's discuss the most common intravesical immunotherapy, Bacillus Calmette-Guérin (BCG) treatment. What is it?

VICTORIA WEBBER: BCG is an inactivated tuberculosis bacteria (mycobacterium bovis) that is typically used as a tuberculosis vaccine. In bladder cancer, BCG is used as an intravesical immunotherapy. It is not chemotherapy. It works to prevent bladder cancer recurrence by activating your immune system to send specialized cells to the bladder to attack and kill any remaining cancer/abnormal cells.

How is BCG treatment administered? How should patients prepare?

VICTORIA WEBBER: Treatment is administered in liquid form through a small catheter into the bladder. Patients are numbed with lidocaine gel before we insert the catheter. The procedure is not painful, but it might be a little uncomfortable. It typically takes less than five minutes to complete. No specific preparation is required for BCG treatments, but you should always inform your provider of any UTI symptoms before any treatment.

Patients should hold the medication in their bladder for two hours. After the two hours, patients should void in a private toilet and follow the instructions given to them by their provider to decontaminate the toilet. You must decontaminate it because BCG is a live product with active bacteria that can cause infection.

To decontaminate, your provider will likely instruct you to flush twice with the lid down after voiding the BCG into the toilet. Pour household bleach into the toilet and let sit for 15 minutes with the lid down before flushing again. Wash hands and genital area with water and soap after voiding.

What are the potential side effects of BCG treatment?

VICTORIA WEBBER: BCG is usually well tolerated, and patients typically experience short-term, minor side effects. After each instillation, patients may experience some burning with urination, increased urinary frequency/urgency, mild blood in the urine, low-grade fever, muscle/joint aches, and/or malaise and fatigue. These symptoms typically resolve within 24 to 48 hours.

Will BCG treatment affect a patient's daily life and activities?

VICTORIA WEBBER: Patients may feel under the weather for up to 24 to 48 hours after each instillation, but they may continue their normal daily activities if they are up to it. I typically tell patients they can expect to feel like they do after receiving a vaccine.

How long does a course of BCG treatment last?

VICTORIA WEBBER: Typically, patients undergo induction of BCG first, which consists of six weekly instillations. Patients who remain disease-free after completing induction BCG may continue with maintenance BCG. Maintenance BCG consists of three weekly instillations every few months for up to three years (most commonly at three months, six months, then every six months for one to three years).

Is BCG treatment contagious/hazardous to others?

VICTORIA WEBBER: BCG contains a live bacterium that has been modified and weakened to make it less likely to cause disease. We still recommend taking precautions (like bleaching the toilet after voiding) to avoid potential exposure to the BCG, as there is still a small chance it can be transmitted and cause disease in others, especially those who are immunocompromised.

Patients can remain in close contact with others after their treatment but should be sure that no one is in contact with their urine. When it comes to sex, patients should discuss restrictions with their healthcare provider. Generally, patients should avoid sexual activity for a few days after treatment. While undergoing BCG treatment, patients should use condoms or barriers whenever having intercourse or oral sex.

You must also be mindful about how you wash your clothes. If your urine comes in contact with clothing or towels, you should wash them twice in a washing machine with normal detergent and hot water, separately from other clothes. (Use gloves to handle contaminated clothing.)

Again, your healthcare provider will have specific instructions regarding voiding, sexual activity, laundering clothes, and any other things you need to know. Make sure you and those caring for you understand all the instructions—and make sure you follow them.

How effective is BCG treatment in curing bladder cancer and preventing recurrence?

VICTORIA WEBBER: BCG is not considered a "cure" for bladder cancer, but studies have shown that it significantly reduces the rate of bladder cancer recurrence.

What else would you like people to understand about BCG treatment for bladder cancer?

VICTORIA WEBBER: It is a well-tolerated, localized treatment for bladder cancer that helps prevent recurrence.

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