A 58-year-old male presents to the clinic with a 2-month history of painless hematuria (blood in the urine). He reports noticing blood in his urine intermittently, especially at the end of urination, but denies any associated pain, urgency, or dysuria (painful urination). There has been no recent trauma or infection, and he has not had any significant weight loss or night sweats. The patient has a history of smoking for 30 years, with about a pack per day, but he quit 5 years ago. He also has a history of hypertension, controlled with medication.

On physical examination, the patient is well-nourished and in no apparent distress. The abdominal exam reveals no tenderness, masses, or organomegaly. A digital rectal exam (DRE) is performed and does not reveal any abnormalities of the prostate. There is no lymphadenopathy or hepatosplenomegaly. The rest of the physical exam is unremarkable.

Given the clinical presentation, further evaluation with a urine analysis and urine cytology is performed, which confirms the presence of hematuria and atypical cells. A cystoscopy is conducted, revealing a suspicious lesion in the bladder wall, which is consistent with a bladder tumor. A biopsy of the lesion confirms the diagnosis of transitional cell carcinoma (TCC) of the bladder.

The patient is referred to an oncologist for staging, further assessment, and management options, including possible transurethral resection of the bladder tumor (TURBT), followed by chemotherapy or immunotherapy, depending on the stage and grade of the tumor.