When Hematuria Isn't Investigated: Bladder Cancer in Oregon

Blood in the urine can be scary. It can come from something minor, like a urinary tract infection (UTI). But sometimes it is the first sign of bladder cancer. When a doctor blames the blood on a UTI and never looks further, a serious diagnosis can be delayed.

This article explains what "hematuria" means, when medical guidelines call for a closer look, and how a delayed bladder cancer diagnosis is evaluated under Oregon medical-malpractice law. It is educational only. It does not tell you whether you have a claim.

What hematuria is

Hematuria is the medical word for blood in the urine. Sometimes there is enough blood to change the urine's color: the American Cancer Society says it may turn the urine orange or pink, or, less often, dark red. Other times the urine's color is normal, but small amounts of blood are found when a urine test, called a urinalysis, is done.¹

According to the American Cancer Society, blood in the urine is most often the first sign of bladder cancer.² Early bladder cancer usually causes bleeding but little or no pain.³ The bleeding can also come and go. Blood may not appear every day, and it can disappear and then return later.⁴

Why a UTI is not always the answer

Blood in the urine has many causes. It is more likely to come from a non-cancer cause, such as an infection, a benign tumor, a kidney or bladder stone, or another non-cancer kidney condition than from cancer.⁵ Bladder symptoms such as burning or having to go more often are also more likely to be caused by something other than cancer, such as a UTI.⁶

The American Urological Association (AUA) guideline addresses what happens after a UTI is blamed. It states: "In patients with hematuria attributed to a urinary tract infection, clinicians should obtain a urinalysis with microscopic evaluation following treatment to ensure resolution of the hematuria." The guideline adds that if the microhematuria does not clear after the UTI is treated, a risk-based urologic evaluation should be performed.⁷ The National Cancer Institute reports that smoking is a major risk factor for bladder cancer, and that the risk also rises with age and with workplace exposure to paints, dyes, metals, or petroleum products.⁸

What the standard of care asks for

Medical groups have published guidelines for how to handle hematuria. The AUA tells clinicians to sort patients with microscopic hematuria into low, intermediate, or high risk for a urinary-tract cancer, based on factors like age, smoking history, and how much blood is present.⁹ For intermediate-risk patients, the guideline recommends a cystoscopy and a renal ultrasound.¹⁰ A cystoscopy is a procedure done by a urologist. A long, thin, flexible tube with a light and a lens or small video camera on the end is passed through the urethra and up into the bladder, so the doctor can look at the inner lining of the bladder.¹¹ For high-risk patients, the guideline recommends cystoscopy plus imaging of the upper urinary tract, such as a CT scan.¹²

The legal duty itself comes from Oregon statute. ORS 677.095(1) provides: "A physician licensed to practice medicine or podiatry by the Oregon Medical Board has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community."¹³ When blood in the urine is repeatedly written off as a UTI, and no repeat testing, referral to a urologist, or cystoscopy ever happens, those facts raise the question of whether that duty was met.

Why the delay matters

Survival is much higher when bladder cancer is found before it spreads beyond the bladder. The American Cancer Society reports a five-year relative survival rate of about 73% when the cancer is still localized to the bladder. That rate drops to about 41% when the cancer has spread to nearby areas, and to about 9% once it has spread to distant parts of the body.¹⁴

In a medical-malpractice case, the question is not only whether a doctor should have investigated the blood sooner. A lawyer evaluating a delayed diagnosis would also look closely at what the delay changed for the patient.

Oregon's time limits

Oregon law limits how long a patient has to file a medical-malpractice claim. ORS 12.110(4) provides: "An action to recover damages for injuries to the person arising from any medical, surgical or dental treatment, omission or operation shall be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered."¹⁵ In Gaston v. Parsons, 318 Or 247 (1994), the Oregon Supreme Court held that "injury," as used in ORS 12.110(4), "consists of three elements: (1) harm; (2) causation; and (3) tortious conduct." The court held that the period "begins to run when the plaintiff knows or in the exercise of reasonable care should have known facts which would make a reasonable person aware of a substantial possibility that each of the three elements (harm, causation, and tortious conduct) exists."¹⁶ In a missed-diagnosis case, this "discovery rule" is applied to what the patient knew, or should have known, about the earlier hematuria and the later diagnosis.

The same subsection sets an outer limit: "However, notwithstanding the provisions of ORS 12.160, every such action shall be commenced within five years from the date of the treatment, omission or operation upon which the action is based or, if there has been no action commenced within five years because of fraud, deceit or misleading representation, then within two years from the date such fraud, deceit or misleading representation is discovered or in the exercise of reasonable care should have been discovered."¹⁷

Claims against a public body follow a different path. Under the Oregon Tort Claims Act, ORS 30.275(9) requires an action arising from an act or omission of a public body, or of its officers, employees or agents, within the scope of the Act to be commenced within two years after the alleged loss or injury. With a few listed exceptions, that period applies notwithstanding other limitation provisions in ORS chapter 12 or elsewhere. The same section also sets separate notice requirements.¹⁸ Because these deadlines turn on specific dates and facts, the timing of any particular case is something an Oregon attorney would need to review closely.

Where this leaves you

A missed bladder cancer diagnosis does not automatically mean a doctor was negligent. Blood in the urine truly does have many innocent causes, and not every delay falls below the standard of care. But when hematuria is brushed aside as a UTI, when follow-up testing or a urology referral never happens, and when a cancer that could have been caught early is found late, those are the facts an Oregon medical-malpractice lawyer would examine.

If you are worried that blood in your urine, or a loved one's, went uninvestigated, an Oregon attorney can review the medical records and the timeline with you.

This article is educational

This article describes Oregon law in general terms. It is not legal advice and does not create an attorney-client relationship.

Time limits matter. Most Oregon personal-injury and auto-accident claims must be filed within two years of the injury or accident. Medical malpractice claims must be filed within two years of when you knew or reasonably should have known of the negligence, with an outer limit of five years from the act itself (with a fraud exception). Wrongful death claims must be filed within three years of the date of death. Claims against public bodies (cities, counties, state agencies, public hospitals) require a notice of claim within 180 days. Missing these deadlines typically ends a case.

If you think you may have a claim, call Huegli Law at 971-317-6436 for a free case review. Todd Huegli is licensed in Oregon and consults on cases in Oregon only.

Footnotes

1. Bladder Cancer Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html ↩

2. Bladder Cancer Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html ↩

3. Bladder Cancer Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html ↩

4. Bladder Cancer Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html ↩

5. Bladder Cancer Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html ↩

6. Bladder Cancer Signs and Symptoms. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/signs-and-symptoms.html ↩

7. Microhematuria: AUA/SUFU Guideline (2025, unabridged). American Urological Association. https://www.auanet.org/documents/Guidelines/PDF/2025%20Guidelines/MH%20Unabridged%20FINAL.pdf ↩

8. Bladder Cancer Causes and Risk Factors. National Cancer Institute. https://www.cancer.gov/types/bladder/causes-risk-factors ↩

9. Microhematuria: AUA/SUFU Guideline (2025, unabridged). American Urological Association. https://www.auanet.org/documents/Guidelines/PDF/2025%20Guidelines/MH%20Unabridged%20FINAL.pdf ↩

10. Microhematuria: AUA/SUFU Guideline (2025, unabridged). American Urological Association. https://www.auanet.org/documents/Guidelines/PDF/2025%20Guidelines/MH%20Unabridged%20FINAL.pdf ↩

11. Tests for Bladder Cancer. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/how-diagnosed.html ↩

12. Microhematuria: AUA/SUFU Guideline (2025, unabridged). American Urological Association. https://www.auanet.org/documents/Guidelines/PDF/2025%20Guidelines/MH%20Unabridged%20FINAL.pdf ↩

13. ORS 677.095 - Duty of care (ORS chapter 677). Oregon Revised Statutes. https://www.oregonlegislature.gov/bills_laws/ors/ors677.html ↩

14. Survival Rates for Bladder Cancer. American Cancer Society. https://www.cancer.org/cancer/types/bladder-cancer/detection-diagnosis-staging/survival-rates.html ↩

15. ORS 12.110 - Actions for certain injuries to person not arising on contract. Oregon Revised Statutes. https://oregon.public.law/statutes/ors_12.110 ↩

16. Gaston v. Parsons, 318 Or 247, 864 P2d 1319 (1994). Oregon Supreme Court (Caselaw Access Project). https://static.case.law/or/318/cases/0247-01.json ↩

17. ORS 12.110 - Actions for certain injuries to person not arising on contract. Oregon Revised Statutes. https://oregon.public.law/statutes/ors_12.110 ↩

18. ORS 30.275 - Notice of claim; time of notice; time of action (ORS chapter 30). Oregon Revised Statutes. https://www.oregonlegislature.gov/bills_laws/ors/ors030.html ↩