The diagnosis of bladder cancer is made by cystoscopy, which involves inspection of the bladder using a thin telescope through the urethra. The most common symptom is blood in the urine. The first step in treatment usually consists of resecting the tumour using instruments placed through the urethra, usually under a general anesthetic. Many bladder cancers can be cured by this method alone, although there is a tendency for tumours to recur. Therefore, long-term surveillance cystoscopy is required at regular intervals.
Intermediate-aggressiveness tumors have a higher chance of recurring or spreading. This risk can be reduced using instillations of fluid into the bladder once per week for 6 weeks (BCG).
Aggressiveness tumors which have penetrated to the muscular layer of the bladder may require one or a combination of surgery to remove the bladder, radiation, or chemotherapy. Bladder cancers which have spread (metastasized) beyond the bladder are usually treated with chemotherapy.