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Prostate and Urological Health

Diagnosing Bladder Cancer

Stephanie Chisolm, Ph.D.

Director of Education and Research, Bladder Cancer Advocacy Network

Despite it being the sixth most common cancer in the United States, most patients never knew that bladder cancer existed before their diagnosis.

There are no routine screening tests for bladder cancer. The most common clinical sign is painless gross hematuria — blood in the urine that can easily be seen. The hematuria may be occasional and short-lived, and there is likely to be no pain associated with the bleeding. This can cause patients to postpone seeking immediate medical care. In some cases, there is not enough blood for a patient to see (microscopic hematuria), and it is only detected with the help of a urine cytology test done by a physician. Other common bladder cancer warning signs, such as increased urgency and frequency of urination, can also be signs of other urologic conditions. 


To make a bladder cancer diagnosis, a urologist, the medical specialist for urinary diseases, performs a cystoscopy. A narrow tube with a lens on the end allows the urologist to see inside your urethra and bladder, so they can examine these structures for signs of disease. Many patients with the signs above are not referred to a urologist until after their doctors have treated them for possible urinary tract infections. This can lead to a delay in diagnosis.


Bladder cancer is “staged” based on the location of the tumor in relation to the inner lining (urothelium) of the bladder. If a tumor has not grown into the muscle wall of the bladder, it is non-muscle invasive bladder cancer. The tumor can be removed, and local treatments can be put into your bladder to reduce the risk of the cancer returning. Once it grows into the muscle wall of the bladder, because the chance of the cancer spreading to other parts of the body increases, the medical team may suggest removing the bladder (a cystectomy) to reduce the risk of disease progression. A new way for urine to leave your body, called a urinary diversion, is created. When someone is diagnosed with advanced or metastatic bladder cancer, a medical oncologist may be part of the care team. Evidence that the cancer has spread to nearby organs requires more systemic therapies like chemotherapy, immunotherapy, or even targeted therapies.

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