BCG is usually only given after the first occurrence when the diagnosis is high grade. Low grade cancer is initially treated by removal of the tumor and frequent cystoscopy exams. BCG is more effective in high grade where the cells are rapidly dividing. Also, while BCG is relatively safe, it is not without side effects which are cumulative with increasing exposure, so it is best used when really needed.
If, however, low grade bladder cancer returns multiple times, BCG is often used.
Diagnosis 2-08 Small papillary TCC; CIS
BCG; BCG maintenance
Vice-President, American Bladder Cancer Society