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Bladder Cancer

Bladder cancer is the sixth most commonly diagnosed cancer among men and women in the United States.

Risk Factors

  • Smoking
  • Workplace exposures (organic chemicals, dyes)
  • Older age
  • Race and ethnicity (more likely among Caucasians)
  • Chronic bladder irritants (indwelling Foley catheter, chronic infections, untreated urinary tract stones)
  • Genetic factors (family history of bladder cancer)
  • Chemotherapy treatment with cyclophosphamide

Signs and Symptoms

The most common presenting symptom for bladder cancer is blood in the urine, called hematuria. This could be microscopic (red blood cells seen on a urinalysis test, but urine looks clear/yellow) or visible (urine may have drops of blood or appear orange or any shade of pink to red). There are many reasons for blood in the urine besides bladder cancer, such as infection, urinary tract stones, and other benign kidney conditions. It is always important to investigate the cause for blood in the urine with your doctor.

In most cases, there is no pain associated with early-stage bladder cancer. Some may also experience changes in urinary habits or bladder irritation like increased frequency of urination, burning with urination, sense of needing to go right away, changes in the urine stream, waking at night to urinate. These symptoms may also be related to benign conditions (urinary tract infection, overactive bladder, or in men, enlarged prostate).


There is no routine screening method currently recommended for bladder cancer. The important thing is to always have blood in the urine fully checked by a urologist, especially if you have any of the risk factors listed above.


If you see blood in the urine or are found to have blood in the urine on a urine test, you should schedule a consultation with a urologist. Your primary care provider may order some imaging tests (ultrasound of kidneys and bladder or a specialized CT scan of the abdomen and pelvis) to look for causes of blood in the urine.

Your urologist will often perform cystoscopy to identify lesions or masses that may indicate bladder cancer. Cystoscopy is a procedure in which a fiber optic camera is placed through the urethra to directly visualize the lining of the bladder. Under a separate procedure performed under anesthesia—called a bladder biopsy or transurethral resection of bladder tumor (TURBT)—your urologist can remove the lesions/masses and send them to the pathologist to determine if bladder cancer is present and provide a stage.


Bladder cancer is a spectrum of disease where stage is determined by depth of invasion in the layers of the bladder wall. Treatment is then directed based on the depth of invasion. In some cases, a repeat bladder biopsy or TURBT may be necessary.

Your urologist will review the available treatment options based on your pathology stage. For early-stage bladder cancer treatment options may include:

  • Surveillance using special urine studies (cytology) and cystoscopy at regular intervals
  • Intravesical treatments (washes of the bladder with either chemotherapy agents or BCG, a tuberculosis vaccine)

In patients with muscle-invasive (or more advanced) bladder cancer, treatment may involve additional consultations with medical oncology and/or radiation oncology. Treatment options may include some combination of the following:

  • Surgical removal of the bladder (and associated surrounding organs) and urinary diversion using a segment of intestine (called a radical cystectomy with urinary diversion)
  • Chemotherapy
  • Radiation therapy
  • Immunotherapy

Our team is experienced and highly trained to help you through all aspects of bladder cancer care, from diagnosis and treatment to survivorship. No matter where you are in your journey, we are available for consultation and can help to develop a personalized treatment plan.