FAQs

TICE® BCG is a bacterial preparation of a strain called Bacillus Calmette-Guerin (BCG). It contains live, attenuated bacteria.⁶ The medication was developed as a vaccine against tuberculosis but has been found useful in treating certain bladder cancers. Doctors have been using TICE® BCG for many years to treat patients with bladder CIS. It is also effective therapy for treating Ta and T1 papillary tumors that occur in the absence of CIS.

How BCG works to treat bladder cancer is not completely understood. A partial explanation is that it appears to produce an inflammation in the lining of the bladder and it also seems to stimulate the immune system, the body’s defense mechanism against disease.

In order to work, BCG must be in direct contact with the tumor cells. That’s why it is instilled -- administered directly into the bladder -- instead of being given by injection.

BCG is an effective treatment for bladder cancer and is also considered to be an effective preventive therapy for papillary tumors and CIS.^6-8  For BCG to work most successfully, you must actively cooperate with your doctor. This website describes TICE® BCG treatment in general; however, if you need more specific information about your treatment, please speak with your doctor.

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The treatment may be uncomfortable, but it usually isn’t painful. The installation -- the pouring of the medicine into your bladder -- takes only a few minutes. However, the medicine must stay in your bladder for two hours to be fully effective. The process itself is simple.

• Your genital area is cleaned with a sterile solution and you are draped with a sterile sheet.
• A tube (a catheter) is passed through your urethra and into your bladder. Any urine that remains in your bladder can then be removed so that the BCG can easily touch all of the bladder lining.
• The TICE® BCG mixture is administered into your bladder through the catheter.
• The medication stays in your bladder for two hours. During that time, you will be lying down. Your position will be changed from time to time to make sure that the BCG is in contact with all parts of the lining of the bladder long enough to be effective.
• Lying down and changing position may also help to reduce the urge to urinate during the treatment period.

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The exact scheduling of treatment depends on the individual to be treated. These are the steps that are commonly followed:

Initial treatment: Once a week for six weeks (if necessary, this schedule may be repeated once)

Follow-up treatment: Once a month for at least 6 to 12 months

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You will be given specific information about the use of TICE® BCG in your medical facility. The four points given here are important for treatment no matter where it is given.

• Be on time for your appointments. Your TICE® BCG is mixed for you just before your appointment and can only be kept for a short time.
• Do not drink any liquids for four hours before your appointment time.
• Just before your treatment time, urinate to empty your bladder.
• Tell your doctor how you have felt between treatments, especially if you have had a fever, been unusually tired, had chills, or if your urine has contained bright red blood or there have been any blood clots in your urine.

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Some temporary unwanted effects of treatment may occur, such as frequent urination, discomfort with urination, or flu-like symptoms. Most of the reactions are related to irritation of the bladder, but they may affect the whole body. Symptoms typically begin 4 to 6 hours after instillation and last 24-72 hours. 

Notify your doctor at once if you experience any problems, particularly urinary symptoms such as blood in your urine, an urgent or frequent need to urinate, other unusual symptoms, or flu-like symptoms (such as fever, chills, increased fatigue, nausea/vomiting, headache, or dizziness). Also report joint pain, coughing, or rash. It is especially important to report these symptoms to your doctor before you receive the next treatment of BCG. They may be a sign that you have an infection requiring immediate attention. You should be aware that untreated infections have led to death on rare occasions. Symptoms lasting longer than 48 hours or a fever of 101.3°F (or higher) should be reported to your physician immediately.

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Once outside your body, the TICE® BCG fluid may be unsafe for you or others to touch.  With proper and simple precautions, the bacteria are not likely to be passed along to other people.

After treatment, there are some safety steps you must follow:

• For at least six hours after the TICE® BCG treatment, drink plenty of fluids to wash out your bladder.
• To get the medicine out of your bladder, urinate sitting down on the toilet to avoid splashing. Touching the medicine outside the bladder may be unsafe for you and others.
• After you urinate, add two cups of chlorine bleach to the toilet, close the lid, and wait 15 minutes before flushing.
• Wash your genital area and your hands carefully with soap and water each time you urinate.

For six hours after each treatment, follow the four steps given above each time you urinate.

Tell your doctor how you have felt between treatments, especially if you have had a fever, been unusually tired, had chills, or if your urine has contained bright red blood or there have been any blood clots in your urine.

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With proper and simple precautions, the bacteria are not likely to be passed along to other people. After treatment, there are some safety steps you must follow.

• To get the medicine out of your bladder and avoid splashing, sit down on the toilet to pass your urine. Touching the medicine outside the bladder may be unsafe for you and others.
  
• After you urinate, add two cups of chlorine bleach to the toilet, close the lid, and wait 15 minutes before flushing.
  
• Wash your genital area and your hands carefully with soap each time you urinate.
  
• For at least six hours after the TICE® BCG treatment, drink plenty of fluids to wash out your bladder.

For the six hours after each treatment, follow all the steps given above each time you urinate.

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