BCG treatment

This page was reviewed under our medical and editorial policy by

Bertram Yuh, MD, MISM, MSHCPM, Urologic Surgeon, City of Hope | Duarte

This page was reviewed on June 5, 2023.

Bacillus Calmette Guerin (BCG), a type of intravesical immunotherapy, helps the immune system destroy cancer cells and is often used to treat early-stage bladder cancer. BCG is commonly used after TURBT (transurethral resection of bladder tumor) surgery to keep the cancer from coming back.

Considered a type of intravesical therapy, BCG treatment injects a liquid drug directly into the bladder rather than being administered through the bloodstream or by taking a pill.

BCG is made from a strain of bacteria that was originally used to make a vaccine for tuberculosis. The medicine, a weakened version of the vaccine, is injected into the bladder near the tumor through a flexible catheter. The medicine then alerts the immune system to attack the cancer cells.

Is BCG treatment a form of chemotherapy?

BCG is an immunotherapy that helps the body’s immune system fight off cancer cells. Chemotherapy, on the other hand, uses anti-cancer medications to directly kill the cancer cells.

For most patients, BCG treatment usually begins with two-hour sessions once a week for six weeks. If the body responds to the treatments, more sessions may be scheduled.

BCG treatment for bladder cancer

BCG is the standard treatment used for early-stage bladder cancer, and is used specifically on a cancer type known as high-risk non-muscle invasive bladder cancer (NMIBC).

For high-risk stage 0a bladder cancers, BCG is often given shortly after surgery. BCG is also used for stage 0is and stage 1 cancers, which have only spread into the lining of the bladder and not into deeper layers of tissue, muscle or to other parts of the body. BCG isn’t typically appropriate for cancer cells that have spread outside the bladder’s lining.

BCG treatment preparation

Before treatment, the care team will need to know the patient’s health history, including any allergies, medications, recent illnesses or infections, and if they’re pregnant or breastfeeding. In order to prevent diluting the BCG, patients may be advised to stop drinking several hours before the procedure.

The care team may also check the patient’s urine to ensure there’s no bladder infection, and if there is, the treatment will need to be rescheduled.

How BCG treatment is performed

BCG treatment is administered in a liquid form using a catheter inserted into the urethra so the BCG enters directly into the bladder.

Once the BCG has reached the bladder, the patient needs to avoid going to the bathroom for at least two hours in order for the BCG to have time to reach the cancer in the bladder’s lining.

Is BCG treatment contagious?

Because BCG contains live (but weakened) bacteria, precautions are necessary to prevent it from being passed to others.

Patients should go to the bathroom sitting down to reduce splashing and wash their hands thoroughly after urinating. Pouring bleach into the toilet after use may also prevent contamination.

Once home, a patient should drink plenty of liquids and avoid sexual contact with others for 24 hours.

Research has shown that BCG may also reduce the risk of contracting a respiratory tract infection, giving your immune system a boost. However, precautions are still necessary to stay healthy.

The care team will talk to the patient about what to expect and provide instructions to follow at home.

BCG treatment side effects

Like with any medical treatment, it’s possible to experience side effects after BCG. Most side effects may be managed, so a patient should talk to the doctor if experiencing discomfort after the procedure.

Can BCG treatment irritate the bladder?

Discomfort or burning while urinating may occur after BCG treatment, as the treatment may temporarily irritate the bladder. This may feel like a urinary tract infection, causing frequent urination that may be painful.

Other side effects may include:

  • Blood in the urine
  • Chills
  • Muscle pain
  • Fever
  • Skin rash
  • Extreme fatigue
  • Coughing

These side effects usually last two to three days. Long-term side effects from BCG are rare, but if BCG gets into the bloodstream, it may cause a serious infection, even if years have passed since treatment. Patients should alert their doctor if they have a high fever that does not respond to over-the-counter medication or any side effects listed above that do not subside after a few days.

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Show references
  • American Cancer Society (2019, January 30). Bladder cancer surgery.
  • Memorial Sloan Kettering Cancer Center (2021). About your bladder surgery with an ileal conduit (urostomy).
  • National Cancer Institute (2021, August 6). Bladder cancer treatment—patient version.
  • UCLA Urology. Your radical cystectomy guide.
  • American Society of Clinical Oncology (2020, September). Bladder cancer: types of treatment.
  • American Society of Clinical Oncology (2019, June). Urostomy.