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BCG immunotherapy in bladder tumours

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Intravesical BCG has been used to treat bladder cancer since the late 1970's. Given once a week for 6-12 weeks, it destroys carcinoma in situ and superficial tumours, and causes measurable changes in the immune system.

The main problem with intravesical BCG is it's side-effects:

  • systemic "BCG-osis" with lung granulomas, disturbed liver function, fever and malaise; requires prompt anti-tuberculous chemotherapy as may be fatal
  • chemical cystitis
  • flu-like symptoms

Consequently, BCG is usually reserved for:

  • carcinoma in situ
  • high grade superficial tumours i.e. pT1G3
  • pTa and pT1 tumours that have failed to respond to other treatments

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