BCG Treatment for Bladder Cancer: What You Need to Know

BCG treatment for bladder cancer is an immunotherapy used to treat some forms of non-muscle invasive bladder cancer (NMIBC), including carcinoma in situ (CIS). BCG is placed directly into the bladder through a catheter, where it stimulates the immune system to attack cancer cells. Treatment can help reduce the risk that bladder cancer will return or progress.

What is BCG and how does it treat bladder cancer?

BCG [short for Bacille Calmette-Guérin] contains weakened bacteria related to the bacteria used in the tuberculosis vaccine. When BCG is placed directly into the bladder, it triggers an immune response that helps the body’s immune cells attack cancer cells in the bladder lining. This type of treatment is called intravesical immunotherapy.

When is BCG used for bladder cancer?

BCG is primarily used to treat non-muscle invasive bladder cancer (NMIBC). It may be recommended for:

Carcinoma in situ (CIS)

Stage T1 tumors

Intermediate- or high-risk NMIBC when appropriate

The U.S. Food and Drug Administration (FDA) has approved TICE® BCG for the treatment of carcinoma in situ (CIS) and to help prevent the recurrence of certain Ta and T1 bladder tumors after TURBT. Learn more about TICE ® BCG from the FDA.

BCG can be given after a transurethral resection of bladder tumor (TURBT), a procedure used to remove visible bladder tumors and determine the cancer’s stage and grade.

What happens during BCG treatment?

BCG treatment is usually given in a urologist’s office or clinic. The treatment is placed directly into the bladder.

A catheter is inserted. A healthcare provider passes a thin tube called a catheter through the urethra into the bladder.

BCG is placed into the bladder. The BCG solution passes through the catheter and into the bladder.

The BCG stays in the bladder. Patients are generally asked to hold the solution in their bladder for up to two hours, following their healthcare team’s instructions.

The bladder is emptied. After the treatment period, the BCG solution is emptied from the bladder.

Treatment is repeated. An initial course, called BCG induction, is commonly given once a week for six weeks. Some patients then receive additional BCG called maintenance therapy.

Because BCG contains live bacteria, your healthcare team will give you specific instructions for safely handling urine after treatment. Follow those instructions carefully.

How long does BCG treatment last?

The first course of BCG is called induction therapy and is commonly given once a week for six weeks. If BCG is working, your healthcare team may recommend additional treatments called maintenance BCG to reduce the risk of the cancer returning.

The exact treatment schedule depends on your bladder cancer risk, response to treatment, side effects, BCG availability, and your healthcare team’s recommendations.

What are the side effects of BCG treatment?

Most BCG treatment side effects affect the bladder or cause temporary flu-like symptoms. Common side effects may include:

Burning or discomfort during urination

Frequent or urgent urination

Mild blood in the urine

Fatigue

Low-grade fever or chills

Muscle or joint aches

These symptoms are often temporary. However, BCG can rarely cause a serious infection or other complications.

Contact your healthcare team if your symptoms are severe, do not improve as expected, or you develop a high or persistent fever or other signs of infection. Ask your healthcare team before treatment which symptoms require an urgent call or emergency care.

Bladder cancer patient Damon shares his experience with BCG treatment: “I have responded well to my BCG treatments with minimal side effects. I’ve only experienced flu-like symptoms later in the afternoon after getting the instillation and of course there is some blood in my urine that day, but it’s faint. The following day I’m feeling like myself again.”

What are the benefits of BCG treatment for bladder cancer?

If the doctor decides that this treatment option is right for you, BCG can:

Reduce the risk of bladder cancer recurrence.
Reduce the risk of disease progression.
Treat carcinoma in situ (CIS).
Provide treatment directly inside the bladder.
Help some patients avoid or delay more invasive treatment.

The benefits and risks of BCG vary based on the type of bladder cancer, its stage and grade, previous treatments, and how the cancer responds to therapy.

Is BCG for bladder cancer currently available?

TICE® BCG is currently available in the United States, but supply constraints may occur because of high demand. Availability can vary.

If BCG supply affects your treatment, talk with your healthcare team about your treatment schedule and available options.

Learn more about BCG availability and supply updates.

Frequently asked questions about BCG treatment for bladder cancer

Is BCG a type of chemotherapy?

No. BCG is an immunotherapy. It stimulates an immune response against cancer cells in the bladder. It is delivered directly into the bladder through a catheter.

How many BCG treatments are given for bladder cancer?

BCG induction is commonly given once a week for six weeks. Some patients receive additional maintenance treatments afterward. Your schedule depends on your cancer risk, response to treatment, side effects, and your healthcare team’s recommendations.

How long does BCG stay in the bladder?

Patients are generally instructed to keep BCG in the bladder for up to two hours. Your healthcare team will give you specific instructions for your treatment.

What are the most common BCG treatment side effects?

Common side effects include burning during urination, frequent or urgent urination, mild blood in the urine, fatigue, low-grade fever, chills, and flu-like symptoms. Severe or persistent symptoms should be reported to your healthcare team.

Can bladder cancer come back after BCG treatment?

Sometimes. BCG reduces the risk of recurrence for appropriate patients, but bladder cancer can still return. Regular follow-up with cystoscopy and other tests is important after treatment.