Immunotherapy is treatment that uses the body’s own natural defences (immune system) to fight disease. Bacillus Calmette-Guérin (BCG) is a vaccine that was originally used to prevent tuberculosis. It can also stimulate a person’s immune system to stop or delay bladder cancer coming back or becoming invasive.
Learn more about:
- How is BCG given?
- Ongoing BCG treatment
- Side effects of BCG
- BCG safety at home
- Video: What is immunotherapy?
- Podcast: What are immunotherapy and targeted therapy?
How is BCG given?
The most effective way to treat high-risk superficial bladder cancer is with a combination of BCG and TURBT. BCG is given once a week for 6 weeks, starting 2–4 weeks after TURBT surgery. It is put directly into the bladder through a catheter.
You may be asked to change position every 15 minutes so the vaccine washes over the whole bladder. This is usually done as a day procedure in hospital, and each treatment session takes up to 2 hours.
The BCG vaccine contains live bacteria, which can harm healthy people, so your treatment team will tell you what safety measures to follow at home. Speak to your medical team if you have any questions.
Let your doctor know of any other medicines or complementary therapies you are using, as they may interfere with how well the bladder cancer responds to BCG. For example, the drug warfarin (a blood thinner) is known to interact with BCG.
Ongoing BCG treatment
For most people with high-risk superficial bladder cancer, the initial, 6-week course of BCG treatments is followed by more BCG. This is called maintenance BCG and it reduces the risk of the disease coming back or spreading.
Maintenance treatment can last for 1–3 years, but treatment sessions become much less frequent (e.g. one dose a month). Treatment schedules can vary so ask your doctor for further details and see below for safety measures to take at home.
Side effects of BCG
Common side effects of BCG include needing to urinate more often; burning or pain when urinating; blood in the urine; a mild fever; and tiredness. These side effects usually last a couple of days after each BCG treatment session.
Less often, the BCG may spread through the body and can affect any organ. If you develop flu-like symptoms, such as fever over 38°C that lasts longer than 72 hours, pain in your joints, a cough, a skin rash, tiredness, or yellow skin (jaundice), contact a nurse or doctor at your treatment centre immediately. A BCG infection can be treated with medicines.
Very rarely, BCG can cause infections in the lungs or other organs months or years after treatment. If you are diagnosed with an infection in the future, it is important to tell the doctor that you had BCG treatment.
BCG safety at home
 | Take care going to the toiletFor 6 hours after BCG treatment, sit on the toilet when urinating to avoid splashing. When finished, pour 2 cups of household bleach (or a sachet of sodium hypochlorite if provided by your treatment team) into the toilet bowl. Wait 15 minutes before flushing twice with the toilet lid closed. Wipe the seat with disinfectant. If clothing is splashed with urine, wash separately in bleach and warm water. |
 | Drink fluidsTo help clear the BCG from your body, drink plenty of liquids for 6–8 hours after treatment. |
 | Handle incontinence pads carefullyIf you use incontinence pads, for a few days after treatment take care when disposing of them. Pour bleach on the used pad, allow it to soak in, then place the pad in a plastic bag. Tie up the bag and put it in your rubbish bin. You may also be able to take the sealed bag back to the hospital or treatment centre for disposal in a biohazard bin. |
 | Drink fluids Practise safe sexFor a week after each treatment, barrier contraception (condoms) to protect your partner from any BCG that may be present in your body fluids and to prevent pregnancy. |
 | Wash hands wellFor a few days after each treatment, wash your hands extra well after going to the toilet. If your skin comes in contact with urine, wash or shower with soap and water. |
→ READ MORE: Muscle-invasive bladder cancer treatment
Video: What is immunotherapy?
Podcast: What are immunotherapy and targeted therapy?
Listen to more episodes from our podcast for people affected by cancer
Dr Prassannah Satasivam, Urologist and Robotic Surgeon, Epworth Hospitals and Cabrini Hospitals, VIC; Donna Clifford, Urology Nurse Practitioner, Royal Adelaide Hospital, SA; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Dr Renee Finnigan, Radiation Oncologist, Gold Coast University Hospital, QLD; Lisa Hann, 13 11 20 Consultant, Cancer Council SA; Dr Andrew Hirschhorn, Director of Allied Health and MQ Health Academy, MQ Health, Macquarie University, NSW; Anne Marie Lyons, Stomal Therapy Nurse, Concord Hospital and NSW Stoma Limited, NSW; John McDonald, Consumer; Prof Manish Patel, Urological Cancer and Robotic Surgeon, Westmead Hospital, Macquarie University Hospital, and The University of Sydney, NSW; Dr Jason Paterdis, Urological Surgeon, Brisbane Urology Clinic, QLD; Graeme Sissing, Consumer; Prof Martin Stockler, Medical Oncologist, The University of Sydney, Concord Cancer Centre, and Chris O’Brien Lifehouse RPA, NSW.
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