BCG bladder treatment

No. BCG is immunotherapy, not chemotherapy, although it is often discussed alongside bladder chemotherapy because both are given the same way. BCG stands for Bacillus Calmette-Guerin, a weakened form of the bacteria used to make the tuberculosis vaccine. For some early bladder cancers that have not grown into the bladder muscle, BCG is placed directly into the bladder through a thin, soft tube called a catheter, passed along the urethra. It is held in the bladder for a period and then passed out in the urine. The BCG does not kill cancer cells directly. Instead, it triggers the immune system in the bladder lining to become active and attack abnormal cells, which can reduce the chance of the cancer coming back or progressing.

Because BCG contains live bacteria, the precautions and side effects are different from bladder chemotherapy such as mitomycin. Most people have bladder irritation for a day or two after each treatment, with burning, needing to pass urine often and urgently, and sometimes a little blood in the urine, along with mild flu-like tiredness or a low fever. These usually settle. Less commonly, BCG can spread beyond the bladder and cause a serious infection, which needs urgent treatment with specific antibiotics. Home precautions focus on safe toilet hygiene for some hours after each treatment, so that the live bacteria in urine do not affect others. BCG is usually given as a course of weekly treatments followed by maintenance treatments over a longer period, depending on the plan your urologist recommends.

It is not a vaccination against cancer

BCG in the bladder works locally on the bladder lining. It does not vaccinate you against cancer.

Tell your team about your immune system

BCG may not be suitable if your immune system is weakened by illness or medicines.

Report fever that does not settle

A high or persistent fever after BCG needs same-day assessment.

It cannot tell you whether BCG is the right treatment for your bladder cancer, or how many treatments you will need. That depends on the type and grade of the cancer, which describes how abnormal the cells look under the microscope, and on your overall health. Your urologist will explain the plan.

It also cannot tell you whether a symptom after BCG is normal or a sign of infection. When in doubt, call your team.

Supply and availability

BCG supply has sometimes been limited. If your treatment is delayed, ask your team about alternatives.

Sex and BCG

Condoms are usually advised for a period after each treatment. Ask your team for specific advice.

Pregnancy and breastfeeding

BCG is not given during pregnancy or breastfeeding. Tell your team if this may apply.

Other medicines

Some antibiotics and steroids can affect how BCG works. Tell your team about all medicines.

Tuberculosis history

Tell your team if you have had tuberculosis or are being treated for it.

Emotional side

Repeated bladder treatments and check-up cystoscopies can be tiring and stressful. Support helps.

Follow-up cystoscopies

Regular camera checks of the bladder are part of treatment. Keep these appointments.

Missed treatments

If you miss a treatment because of side effects or illness, your team will advise how to continue.

Why BCG is used for early bladder cancer

Early bladder cancers that sit on the inner lining of the bladder often come back after they are removed with a telescope operation, and some can become more serious over time. BCG treatment aims to reduce this risk by training the immune system in the bladder lining to recognise and attack abnormal cells. It is usually given in a course over several weeks, followed by maintenance treatments at intervals, alongside regular camera checks of the bladder. Your urologist will explain whether your type of bladder cancer is one where BCG is recommended, and what the alternatives would be, such as bladder chemotherapy or, in some cases, surgery.

Coping with repeated treatments

A long course of BCG with frequent catheter treatments and cystoscopies can be tiring and uncomfortable, and some people feel anxious before each session. Planning treatment days with lighter commitments, drinking fluids afterwards, resting if you feel flu-like, and talking to your team about side effects can make the course easier. If side effects become difficult, your team may adjust the schedule rather than stopping altogether.

What to do next

Ask your urologist why BCG is recommended, how many treatments are planned, and what to do before and after each session. Follow toilet precautions, drink fluids as advised afterwards, and report persistent fever, severe symptoms or blood clots straight away.