# Care pathway for bladder cancer On this page you will find information about the different stages of examinations and treatment of bladder cancer at HUS. ## [ From symptoms to diagnosis ](#from-symptoms-to-diagnosis) ## [ Getting a diagnosis ](#getting-a-diagnosis) ## [ Treatments ](#treatments) ## [ After treatments ](#after-treatments) ## From symptoms to diagnosis Primary health care ### A symptom appears or an abnormal finding is made --- The most common first symptom of bladder cancer is bloody urine, or hematuria, which occurs in approximately 85–90% of the patients. Hematuria can be detected by the eye as blood in the urine or under a microscope. The intensity or duration of the presence of blood in the urine does not indicate the severity of the potential bladder cancer. The risk of bladder cancer increases in male patients over the age of 40 who smoke. Only one in five patients with hematuria is diagnosed with bladder cancer. One-third of bladder cancer patients experience other symptoms in addition to hematuria, such as frequent urination, pain, or urinary urgency. If blood is detected in your urine, for example during a screening test, no further tests for bladder cancer are needed if you do not have any other symptoms or risk factors for bladder cancer. However, the cause of an abnormal finding in a urine sample should be investigated even if bladder cancer is not suspected. ### Required additional examinations in primary health care and a physician’s assessment --- If the patient’s urine is visibly bloody, an urgent ultrasound examination of the urinary tract and necessary additional examinations are performed in primary health care. An ultrasound examination excludes possible obstacles to the passage of urine, as well as the possibility of renal cancer. ### A physician writes a referral --- A physician will refer you to HUS Urology Outpatient Clinic if: - your urine is visibly bloody or - hematuria is detected under a microscope and you have risk factors for bladder cancer or symptoms related to urination. ## Getting a diagnosis Comprehensive Cancer Center and other specialized medical care ### The referral arrives at specialized medical care and an invitation is sent to the patient --- When your referral arrives at HUS, a specialist reviews it, assesses its urgency and plans the necessary additional examinations, such as various imaging examinations and blood sampling. When bladder cancer is suspected, the primary examination is an endoscopy of the bladder, i.e. cystoscopy. We perform cystoscopies at the outpatient clinic using a flexible cystoscope. The procedure is painless. Bladder cancer is usually easy to identify in the cystoscopy. You will receive an invitation letter in the mail indicating when and in which hospital you will need to arrive, which procedure has been booked for you, and instructions on how to prepare for coming to the hospital. You can reschedule or cancel your appointment by calling the number indicated in the invitation letter. Tumor removal is, along with diagnosing, the first step in the treatment of bladder cancer. ### If necessary, additional examinations can be carried out --- Ultrasound imaging cannot completely rule out tumors of the surface of the bladder or upper urinary tract, i.e. the urothelium. Therefore, when bladder cancer is suspected, we also examine the extent of the disease with contrast-enhanced computed tomography. If you cannot have a CT scan due to an iodine allergy or severe kidney failure, we will examine your upper urinary tract with magnetic resonance imaging. We will renew the cystoscopy, i.e. the endoscopic examination of the bladder as needed. If the disease has spread, a biopsy of the metastases may be taken. ### Appointment with a physician and a nurse --- At the appointment, we will make a personal treatment plan for you. ## Treatments Specialized medical care ### Treatment begins --- In addition to surgery, bladder cancer can be treated with intravesical chemotherapeutic or immunological irrigation of the bladder and, in some cases, radiation therapy. [ Read more about the treatment of bladder cancer ](/en/patient/treatments-and-examinations/cancer/care-pathway-bladder-cancer/treatment-bladder-cancer) ### Healing and follow-up --- We monitor patients with low-risk bladder cancer at a HUS urology for five years with regular cystoscopies and urine cytology. We monitor patients with high-risk bladder cancer according to the patient’s general condition and age. After surgery with a curative goal, your follow-up with urology will continue for five years. We monitor metastatic bladder cancer at the Comprehensive Cancer Center. Metastatic bladder cancer is considered an incurable disease, but some patients respond exceptionally well to cancer treatment. If no evidence of cancer is detected within five years, your follow-up will be ended. ### If the disease recurs or treatments do not help --- In locally recurrent bladder cancer, we make a patient-specific treatment plan with urology. Drug treatments for bladder cancer require the patient to have good general condition and good kidney function. With medical treatments, we can try to prolong your life expectancy, but your quality of life may suffer. With the most commonly used intravenous chemotherapy, about half of the patients experience a reduction in the disease. We can also reduce the number of metastases causing individual symptoms with the help of locally administered radiation therapy. [At the Clinical Trial Unit](/en/patient/hospitals-and-other-units/comprehensive-cancer-center/clinical-pharmaceutical-research-unit "Clinical Trial Unit, Comprehensive Cancer Center") we offer an increasing number of patients the opportunity to be among the first to receive new research treatments. ### Palliative care and psychosocial support --- Good palliative care and psychosocial support are an integral part of cancer treatment. The Palliative Care Center provides help in the stressful life situation caused by the illness or cancer treatments. We help treat difficult symptoms and offer conversational support. A decision on palliative, i.e. symptomatic, treatment is made when the focus of your treatment shifts from slowing down the progression of cancer to managing the symptoms. In this case, treatment aims to alleviate symptoms and, as far as possible, to ensure a good and active life with the illness until death. Typically, at this stage, your care responsibility is transferred to the palliative care unit or to the palliative outpatient clinic or hospital-at-home unit in your area. [ Read more about the Palliative Care Center ](/en/patient/hospitals-and-other-units/comprehensive-cancer-center/palliative-center-comprehensive) ## After treatments ### Follow-up in specialized medical care ends --- If your bladder has been removed in surgery, the monitoring of your urinary tract function will continue for the rest of your life. Follow-up can be carried out in primary health care. The function and structure of the kidneys is monitored annually with blood tests and ultrasound examinations. Updated: 12.03.2026