<prompt> BCG is used in the treatment of:Carcinoma colonCarcinoma cervixCarcinoma of urinary bladderAll  <response>: Ans. c Carcinoma of urinary bladder. Ref. Bailey and Love 25thpg. 1335; Harrison medicine 17thTable 90-2IMPACT 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 surgeryMetastatic 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. 