BCG is used in the treatment of:

Ans. c (Carcinoma of urinary bladder). (Ref. Bailey and Love 25th/pg. 1335; Harrison medicine 17th/Table 90-2)IMPACT OF BCG WITH TURTUR with intravesical BCG provides a significantly better prophylaxis of tumour recurrence in Ta and T1 bladder cancer than alone TUR.Indications for intravesical therapy:# Multifocal Ta disease is a relative indication for intravesical therapy.# Infrequent recurrence of low-grade stage Ta disease can be treated with repeated resection; and if recurrence is noted with in 2yrs intravesical therapy should be considered.# Patient with grade III disease regardless of tumor stage should be referred for intravesical therapy.# Positive cytology finding after TUR of bladder, recurrent tumor, extravesical urothelial tumor, and presence of urothelial dysplasia. Even small focus of CIS is definite indication for intra-vesical therapy.# Intravesical immunotherapy has replaced cystectomy as the primary treatment for diffuse CIS, with clinical response reaching 84%.MANAGEMENT OF BLADDER CANCERNature of LesionManagement ApproachSuperficialEndoscopic removal, usually with intravesical therapyinvasive diseaseCystectomy +- systemic chemotherapy (before or after surgery)Metastatic diseaseCurative or palliative chemotherapy (based on prognostic factors) +- surgerySuperficial Disease - Intravesical therapies are used in two general contexts:# As an adjuvant to a complete endoscopic resection to prevent recurrence or, less commonly,# To eliminate disease that cannot be controlled by endoscopic resection alone.- Intravesical treatments are advised for patients with recurrent disease, >40% involvement of the bladder surface by tumor, the presence of diffuse CIS, or T1 disease.- Bacillus Calmette-Guerin (BCG) in six weekly instillations, followed by maintenance, is considered standard based on randomized comparisons.- Other agents with activity include - mitomycin-C and interferon (IFN).- The side effects include dysuria, urinary frequency, and, depending on the drug, myelosuppression or a contact dermatitis.- Rarely, intravesical BCG may produce a systemic illness associated with granulomatous infections in multiple sites that requires antituberculin therapy.- Following the endoscopic resection, patients are monitored for recurrence at 3-month intervals during the first year.- Those with persistent disease or new tumors are generally considered for a second course of BCG or for intravesical chemotherapy with valrubicin or gemcitabine.