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Bacillus Calmette-Guerin (BCG, TICE®, TheraCys®)

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Last Modified: August 21, 2011

Pronounced: bah-sill-uhs kahl-met gey-rahn
Classification: Biologic Response Modifier

About Bacillus Calmette-Guerin

Bacillus Calmette-Guerin (BCG) is an inactivated form of the tuberculosis virus. It works against cancer as a biologic response modifier. Biological response modifiers are substances that have no direct antitumor effect, but are able to trigger the immune system to attack tumors. BCG is thought to work by stimulating an immune response and causing inflammation of the bladder wall that, in turn, destroys cancer cells within the bladder.

How to Take Bacillus Calmette-Guerin

BCG is given directly into the bladder (intravesically) through a catheter. The urinary catheter is inserted through the urethra (the tube which carries urine from the bladder to the outside the body). The BCG solution is injected into the catheter, which is then clamped off, allowing the medication to remain in the bladder. The catheter may be removed or remain in place for the time the BCG is required to remain in the bladder. The patient is encouraged to roll from side to side and to lie on his/her back to help the medication reach all areas of the bladder. After a predetermined time (usually about 2 hours) the catheter is unclamped, the fluid is drained, and the catheter is removed. Treatments are usually given on a weekly basis, for 6 weeks, followed by treatments once a month, for 6 to 12 months. Your doctor will determine your exact treatment schedule and dose.

Safety Considerations When Receiving BCG:

• Limit your fluid intake for 4 hours before the procedure so you will be able to hold the medication in your bladder during the treatment. Do not drink caffeinated drinks for 4 to 6 hours before and for 2 hours after the procedure. Caffeine has a diuretic (need to urinate) and irritant effect, which could make the treatment difficult.
• To avoid transmission of BCG to others, for 6 hours after treatment patients should void (urinate) while seated to avoid splashing of urine. Urine voided during this time should be disinfected with 2 cups of household bleach into the toilet water and letting it stand for 15-20 minutes before flushing.
• In addition, washing the genital area after urination can prevent irritation from exposure of the skin to BCG.
• Men having this treatment can pass on BCG during sex. To protect your partner from coming into contact with BCG, you should not have sex for 48 hours after each treatment. Use a condom if you have sex at other times during the treatment course and for six weeks after treatment has ended.

Possible Side Effects of Bacillus Calmette-Guerin

There are a number of things you can do to manage the side effects of Bacillus Calmette-Guerin. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Urinary Symptoms

Including: Painful or difficult urination, urgency (the need to urinate often), urinating small amounts (frequency), blood in the urine (hematuria), and incontinence.

These symptoms tend to resolve within 48 hours after treatment. If symptoms persist, let your doctor or nurse know.

Flu-Like Symptoms

Fever, chills, muscle aches, and fatigue. Your doctor or nurse can recommend a mild pain reliever, such as acetaminophen or ibuprofen, to relieve these symptoms. These symptoms should also resolve within 48 hours of treatment.

BCG Reaction

This rare reaction to BCG can occur following exposure to BCG, generally within one week of a biopsy, TUR (trans-urethral resection) surgery, or traumatic bladder catheterization. Symptoms of a BCG reaction include unexplained high fever lasting 24-48 hours or more, chills, confusion, dizziness or lightheadedness (symptoms of low blood pressure) or shortness of breath. BCG reaction can cause pneumonitis (inflammation of the lungs), hepatitis, prostatitis (infection or inflammation of the prostate), epididymal-orchitis (inflammation of the testicles), respiratory distress and other symptoms of sepsis (widespread infection). You should notify your doctor immediately if you experience any of these symptoms.