Dr. Jennifer Linehan, a urological oncologist at Providence St. John’s Cancer Institute, approaches bladder cancer care through a comprehensive lens that begins with early detection and extends through advanced treatments and clinical trials. As the field evolves, patients now have access to more precise, personalized, and bladder-sparing options than ever before.
Understanding Bladder Cancer Diagnosis
Dr. Linehan explains that Bladder cancer often first presents with a symptom that can be easy to overlook: blood in the urine. In many cases, patients experience no pain or discomfort, and the bleeding may only be detected during routine testing. This initial sign typically leads to further evaluation by a urologist.
Oftentimes, the most common presentation is blood in the urine. Patients don’t have pain, they done have burning. They just see the blood.
– Jennifer Linehan, MD
To determine where the bleeding is coming from, physicians usually begin with imaging, most commonly a CT scan, to evaluate the kidneys, ureters, and bladder. From there, the focus shifts to identifying what may be happening inside the bladder itself.
Urine-based testing plays an important role in diagnosis. Traditional cytology looks for cancer cells in the urine, although it is more reliable for higher-grade tumors. Newer urine tests now analyze DNA and genetic markers associated with bladder cancer, offering additional insight and, in some cases, helping guide treatment decisions.
This is a really exciting area, because these tests don’t just help us detect cancer early, they can also help us understand which treatments a patients may respond to.
– Jennifer Linehan, MD
If any suspicious areas are found, a biopsy may be performed, or the tumor may be removed entirely. Smaller lesions can sometimes be treated in the clinic, while larger tumors are typically removed in the operating room using minimally invasive techniques.
Diagnosing Bladder Cancer with Dr. Linehan
Dr. Jennifer Linehan in Saint John’s Cancer Institute 2026
Treatment Options and Bladder-Sparing Therapies
Once a diagnosis is confirmed, treatment depends on whether the cancer is low-grade or high-grade, and whether it has invaded the muscle layer of the bladder.
For many years, muscle-invasive bladder cancer was treated with removal of the bladder, known as a cystectomy, often combined with chemotherapy. While this approach is still necessary in some cases, treatment options have expanded significantly.
Dr. Linehan further discusses Bladder-sparing therapy for muscle-invasive bladder cancer here, also called trimodal therapy, which offers an alternative for select patients. This approach combines chemotherapy, sometimes immunotherapy, surgical removal of as much of the tumor as possible, and targeted radiation therapy. When used together, these treatments can be highly effective, allowing some patients to keep their bladder without compromising cancer control.
When you put these treatments together, we’re seeing very strong success rates, and in many cases, patients are able to keep their bladder.
– Jennifer Linehan, MD
For patients with non–muscle-invasive bladder cancer, treatment is often delivered directly into the bladder. These therapies may include chemotherapy, immunotherapy, or newer gene-based treatments designed to eliminate tumors and reduce the risk of recurrence.
Advances in radiation and surgical techniques have also improved precision and outcomes. Newer technologies, including laser-based treatments, allow for more targeted approaches while minimizing impact on surrounding healthy tissue.
Clinical Trials and Emerging Therapies
Clinical trials are playing an increasingly important role in bladder cancer care, offering patients access to new and evolving treatment options.
I think what’s different now is that clinics trials aren’t just a last option. In some cases, they may actually be the best first option for patients.
– Jennifer Linehan, MD
For patients with non–muscle-invasive disease, many trials focus on therapies delivered directly into the bladder. Some are designed to treat tumors while also preventing them from coming back. Others use more targeted approaches, such as delivering therapy directly to cancer cells and activating it with light or laser.
For high-grade cancers, especially in light of shortages of traditional treatments like BCG, new alternatives have emerged. These include established drug combinations as well as newer gene therapy–based approaches.
Importantly, clinical trials are no longer viewed as a last resort. In some cases, they may be considered early in the treatment process because they offer access to some of the most advanced therapies available. If a trial is not available at one institution, patients can often be referred to other centers to find the right option. Dr. Linehan discusses clinical trials for low- and high-grade bladder cancer patients using intracavitary treatments as primary treatment. See Bladder Cancer Clinical Trials: Evaluation of High and Low-grade Cancer.
Bladder cancer care today is highly individualized. Decisions are based on factors such as tumor grade, size, number, and whether the cancer has invaded the bladder muscle. With a growing range of diagnostic tools, treatments, and clinical trials, the goal is to match each patient with the most effective and appropriate care for their specific situation.
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