Bladder cancer
What the FAA's documents say about bladder cancer, in plain words, with the FAA's own words one press away.
Short version
The FAA's table sorts it into three rows.
| Situation | What the examiner does | Pathway |
|---|---|---|
| Row ANon metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence or ongoing treatment. | Examiner issues | Examiner can issue |
| Row BNon metastatic, with treatment completed less than five years ago. The table sends a local recurrence within the bladder only to the same worksheet. | Worksheet | CACI |
| Row CMetastatic disease, muscle invasion, or recurrent disease that has spread outside the bladder. | Defers to the FAA | FAA review |
Show the FAA's words: the FAA's table for Bladder cancer
- Row A · Examiner can issue
Non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence or ongoing treatment. The table says ISSUE, and has the examiner summarize this history in Block 60.
Non metastatic and treatment completed 5 or more years ago … No recurrence or ongoing treatment: … ISSUE … Summarize this history in Block 60.
- Row B · CACI
Non metastatic, with treatment completed less than five years ago. The table sends a local recurrence within the bladder only to the same worksheet. The table sends the examiner to the CACI worksheet for bladder cancer, and has the examiner note it in Block 60.
Non metastatic and treatment completed less than 5 years ago … See CACI – Bladder Cancer Worksheet. Local recurrence within the bladder only: Follow CACI – Bladder Cancer Worksheet. … Follow the CACI – Bladder Cancer Worksheet ( PDF ) Note in Block 60.
- Row C · FAA review
Metastatic disease, muscle invasion, or recurrent disease that has spread outside the bladder. The examiner defers. The table says the information for an initial issuance is submitted to the FAA, and that follow-up issuance will be per the pilot's authorization letter.
Metastatic disease, muscle invasion, or Recurrent disease that has spread outside the bladder … DEFER Initial Issuance -Submit the information to the FAA. … Follow-up Issuance -Will be per the airman's authorization letter.
- A note on the table, 1
The table's note says that if the pilot is currently on radiation or chemotherapy, the treatment course must be completed before medical certification can be considered.
Notes regarding Bladder Cancer : If the airman is currently on radiation or chemotherapy, the treatment course must be completed before medical certification can be considered.
- A note on the table, 2
The worksheet's note says that if it has been five or more years since the pilot had any treatment for this condition, with no history of metastatic disease and no reoccurrence, CACI is not required, and the examiner notes this in Block 60 (the note points to the disposition table).
Notes: If it has been 5 or more years since the airman has had any treatment for this condition, with no history of metastatic disease, and no reoccurrence, CACI is not required. Note this in Block 60. (See disposition table.)
The FAA pathways for bladder cancer
Which exam
Your step-by-step plan
Step 1: The progress note from the treating doctor or specialist
The note the examiner reviews, and what it verifies.Within 90 days before the examOne question insideA current, detailed progress note from a clinic visit with your treating physician or specialist, no more than 90 days before the exam. Your AME reviews it.
It verifies
- The condition is stable
- No current or historic evidence of any metastatic disease or muscle invasion
- Active treatment (chemotherapy, radiation, etc.) completed, with no new treatment recommended at this time; and/or (the worksheet's word) its item on surgery
After a recurrence
- No spread outside the bladder
After surgery
- Off pain medication
- A full recovery
- Released by the surgeon
Show the FAA's words: The progress note from the treating doctor or specialist
the AME must review a current, detailed Clinical Progress Note generated from a clinic visit with the treating physician or specialist no more than 90 days prior to the AME exam.
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
Condition is stable;
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
There is no current or historic evidence of any metastatic disease or muscle invasion;
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
Active treatment is completed (chemotherapy/radiation, etc.) and no new treatment is recommended at this time; and/or
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
If recurrence, there has been NO spread outside the bladder;
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
The treating physician’s current, detailed Clinical Progress Note verifies:
If surgery has been performed, the airman is off pain medication(s), has made a full recovery, and has been released by the surgeon. [ ] Yes
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
Step 2: The worksheet's criteria
Your current treatment, and symptoms.No current treatment, or maintenance intravesical BCG or mitomycin.
The worksheet's other criteria
- No symptoms
On chemotherapy or radiation now
If you are currently on chemotherapy or radiation treatment, the worksheet has your AME defer the exam.
Show the FAA's words: The worksheet's criteria
Current treatment
[ ] None or maintenance intravesical BCG or mitomycin. (If these medications are used, the airman should not fly until 24 hours post treatment and asymptomatic.)
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA
Symptoms [ ] None
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
If the airman is currently on chemotherapy or radiation treatment, defer the exam. (See disposition table.
FAA source: CACI – Bladder Cancer Worksheet. FAA date 27 April 2022; checked by Crosscheck 14 October 2026.
What the examiner checks
It depends on which row of the FAA's table describes the case.
Row AExaminer issuesExaminer can issue
The table says ISSUE, and has the examiner summarize this history in Block 60.
Row BWorksheetCACI
The table sends the examiner to the CACI worksheet for bladder cancer, and has the examiner note it in Block 60.
Row CDefers to the FAAFAA review
The examiner defers. The table says the information for an initial issuance is submitted to the FAA, and that follow-up issuance will be per the pilot's authorization letter.
If the examiner defers
Show the FAA's words: what the examiner does on each row
- Row A · Examiner can issue
Non metastatic, with treatment completed five or more years ago. The table's condition for ISSUE is no recurrence or ongoing treatment. The table says ISSUE, and has the examiner summarize this history in Block 60.
Non metastatic and treatment completed 5 or more years ago … No recurrence or ongoing treatment: … ISSUE … Summarize this history in Block 60.
- Row B · CACI
Non metastatic, with treatment completed less than five years ago. The table sends a local recurrence within the bladder only to the same worksheet. The table sends the examiner to the CACI worksheet for bladder cancer, and has the examiner note it in Block 60.
Non metastatic and treatment completed less than 5 years ago … See CACI – Bladder Cancer Worksheet. Local recurrence within the bladder only: Follow CACI – Bladder Cancer Worksheet. … Follow the CACI – Bladder Cancer Worksheet ( PDF ) Note in Block 60.
- Row C · FAA review
Metastatic disease, muscle invasion, or recurrent disease that has spread outside the bladder. The examiner defers. The table says the information for an initial issuance is submitted to the FAA, and that follow-up issuance will be per the pilot's authorization letter.
Metastatic disease, muscle invasion, or Recurrent disease that has spread outside the bladder … DEFER Initial Issuance -Submit the information to the FAA. … Follow-up Issuance -Will be per the airman's authorization letter.
The CACI worksheet's criteria
Progress note
It verifies
- The condition is stable
- No current or historic evidence of any metastatic disease or muscle invasion
- Active treatment (chemotherapy, radiation, etc.) completed, with no new treatment recommended at this time; and/or (the worksheet's word) its item on surgery
After a recurrence
- No spread outside the bladder
After surgery
- Off pain medication
- A full recovery
- Released by the surgeon
Your current treatment for bladder cancer
The worksheet's other criteria
- No symptoms
On chemotherapy or radiation now
If you are currently on chemotherapy or radiation treatment, the worksheet has your AME defer the exam.
Show the FAA's words: the CACI worksheet's criteria for Bladder cancer
- Stable
FAA criterion: the progress note verifies the condition is stable.
The treating physician’s current, detailed Clinical Progress Note verifies: … Condition is stable;
- If there was a recurrence, no spread outside the bladder
FAA criterion: the progress note verifies that, if there was a recurrence, there has been no spread outside the bladder.
The treating physician’s current, detailed Clinical Progress Note verifies: … If recurrence, there has been NO spread outside the bladder;
- No current or historic evidence of metastatic disease or muscle invasion
FAA criterion: the progress note verifies there is no current or historic evidence of any metastatic disease or muscle invasion.
The treating physician’s current, detailed Clinical Progress Note verifies: … There is no current or historic evidence of any metastatic disease or muscle invasion;
- Active treatment completed, with no new treatment recommended
FAA criterion: the progress note verifies active treatment (chemotherapy, radiation, etc.) is completed and no new treatment is recommended at this time. The worksheet joins this item to the next one, on surgery, with and/or.
The treating physician’s current, detailed Clinical Progress Note verifies: … Active treatment is completed (chemotherapy/radiation, etc.) and no new treatment is recommended at this time; and/or
- If surgery has been performed, off pain medication, a full recovery and released by the surgeon
FAA criterion, where surgery has been performed: the progress note verifies the pilot is off pain medication, has made a full recovery, and has been released by the surgeon.
The treating physician’s current, detailed Clinical Progress Note verifies: … If surgery has been performed, the airman is off pain medication(s), has made a full recovery, and has been released by the surgeon. [ ] Yes
- No symptoms
FAA criterion: no symptoms.
AME MUST REVIEW ACCEPTABLE CERTIFICATION CRITERIA … Symptoms [ ] None
- If currently on chemotherapy or radiation treatment
The worksheet's note says that if the pilot is currently on chemotherapy or radiation treatment, the examiner defers the exam, and points to the disposition table.
If the airman is currently on chemotherapy or radiation treatment, defer the exam. (See disposition table.
If the examiner defersFAA review
The table's last row is metastatic disease, muscle invasion, or recurrent disease that has spread outside the bladder, and the table marks it DEFER.
The worksheet says that if the pilot is currently on chemotherapy or radiation treatment, the examiner defers the exam.
What the FAA lists to send
- Item 1. A current status report from the oncologist describing the treatment plan and the prognosis.
- Item 2. A list of medications, with attention to any chemotherapy agents and the dates used.
- Item 3. Treatment records, including clinic notes or a summary letter describing the initial staging and the treatment course.
- Item 4. Operative notes and the discharge summary, if applicable.
- Item 5. Pathology reports, if applicable.
- Item 6. MRI or CT, or PET scan reports. The table says in some cases the actual CDs will be required in DICOM format for FAA review.
Show the FAA's words: if the examiner defers
When the examiner defers
- Reason 1
The table's last row is metastatic disease, muscle invasion, or recurrent disease that has spread outside the bladder, and the table marks it DEFER.
Metastatic disease, muscle invasion, or Recurrent disease that has spread outside the bladder … DEFER Initial Issuance -Submit the information to the FAA.
- Reason 2
The worksheet says that if the pilot is currently on chemotherapy or radiation treatment, the examiner defers the exam.
If the airman is currently on chemotherapy or radiation treatment, defer the exam. (See disposition table.
What the FAA lists to send
- Item 1
A current status report from the oncologist describing the treatment plan and the prognosis.
Submit the following to the FAA review: … Current status report from oncologist describing treatment plan and prognosis;
- Item 2
A list of medications, with attention to any chemotherapy agents and the dates used.
List of medications with attention to any chemotherapy agents and dates used;
- Item 3
Treatment records, including clinic notes or a summary letter describing the initial staging and the treatment course.
Treatment records including clinic notes or summary letter describing initial staging and treatment course;
- Item 4
Operative notes and the discharge summary, if applicable.
Operative notes and discharge summary (if applicable);
- Item 5
Pathology reports, if applicable.
Pathology report(s) (if applicable); and
- Item 6
MRI or CT, or PET scan reports. The table says in some cases the actual CDs will be required in DICOM format for FAA review.
MRI/CT or PET scan reports (in some cases, the actual CDs will be required in DICOM format for FAA review)
After the FAA decides
AASIThe AASI sheet for bladder cancer says an FAA physician makes the first decision and grants the Authorization. After that, the sheet says the examiner may reissue under the Authorization when the pilot provides what it lists. The table says follow-up issuance will be per the pilot's authorization letter.
Show the FAA's words: after the FAA decides
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR § 67.401 . … Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:
Follow-up Issuance -Will be per the airman's authorization letter.
At later examsAASI
- First and second class
- Every year
- Third class
- At each required exam
The worksheet says first- and second-class applicants must provide this information every year, and third-class applicants must provide it with each required exam.
Show the FAA's words: how often the FAA asks again
Applicants for first- or second-class must provide this information annually; applicants for third-class must provide the information with each required exam.
Under an FAA Authorization, the AASI sheet lists what the pilot provides for the examiner to reissue. That is the Authorization itself, and a current status report performed within 90 days that must include all the required follow-up items and studies as listed in the Authorization letter, and that confirms absence of recurrent disease.
Show the FAA's words: at later exams
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; and … A current status report performed within 90 days that must include all the required followup items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.
What AASI is
AASI stands for AME Assisted Special Issuance. The Guide describes it as a process that lets the examiner reissue a certificate under the provisions of an Authorization for Special Issuance, to an applicant who has a medical condition that is disqualifying under 14 CFR part 67.
How the FAA pathways workThe Authorization granted by the FAA
The AASI sheet's list for a reissue begins with the Authorization the FAA granted.
Show the FAA's words: The Authorization granted by the FAA
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: … An Authorization granted by the FAA; and
A current status report from the last 90 days
The AASI sheet asks for a current status report performed within 90 days that must include all the required follow-up items and studies as listed in the Authorization letter, and that confirms absence of recurrent disease.
Show the FAA's words: A current status report from the last 90 days
A current status report performed within 90 days that must include all the required followup items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.
What the Authorization letter comes with
The AASI sheet says the Authorization letter comes with attachments that specify the information the treating physicians must provide for the reissue determination.
Show the FAA's words: What the Authorization letter comes with
The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination.
When the examiner defers a reissue
The AASI sheet says the examiner must defer to the AMCD or Region if there has been any recurrence of the cancer, or any new treatment is initiated.
Show the FAA's words: When the examiner defers a reissue
The Examiner must defer to the AMCD or Region if: … There has been any recurrence of the cancer; or … Any new treatment is initiated.
Good to know
Points from the FAA's own documents that are easy to miss.
What a progress note must include
In most cases it should come from a visit with the treating physician no more than 90 days ago, and cover the history, medications with dosages and side effects, exam findings, test results, diagnosis, assessment and plan, prognosis and follow-up. The FAA's sheet says to make sure the physician adds the prognosis. A portal note or an After Visit Summary that does not meet these criteria is not enough, and neither is a simple "ok to fly" letter. The FAA's documents also call it a status report.
Show the FAA's words: good to know, 1
your patient portal to print out “notes” or an “After Visit Summary (AVS).” … Patient Portal notes or an AVS that do not meet the criteria listed below for a detailed Clinical Progress Note are NOT sufficient for FAA purposes. … To be “current,” in MOST CASES, the detailed Clinical Progress Note should be from an evaluation in which you saw your treating physician no more than 90 days ago. … It Must include the following items: … A summary of the history of the condition, … Current medications, dosages, and side effects (if any); … Clinical exam findings; … Results of any testing performed; … Diagnosis; … Assessment and Plan; … Prognosis (This item may not be on a standard progress note, make sure your physician adds this information.); and … Follow-up … Please note: A letter stating, “Mr. Smith is ok to fly” (or any other simple note), is NOT a current, detailed Clinical Progress Note and is NOT acceptable. … You may also see this called a “current status report” or “status report” in current FAA Guidance. Any reference to a “status report” equals the criteria listed on this sheet.
Recurrence inside or outside the bladder
A local recurrence within the bladder only goes to the CACI worksheet. Recurrent disease that has spread outside the bladder is in the row the table marks DEFER.
Show the FAA's words: good to know, 2
Local recurrence within the bladder only: Follow CACI – Bladder Cancer Worksheet. … Metastatic disease, muscle invasion, or Recurrent disease that has spread outside the bladder … DEFER Initial Issuance -Submit the information to the FAA.
A 24-hour wait after BCG or mitomycin
Where maintenance intravesical BCG or mitomycin is used, the worksheet says the pilot should not fly until 24 hours after treatment and with no symptoms.
Show the FAA's words: good to know, 3
[ ] None or maintenance intravesical BCG or mitomycin. (If these medications are used, the airman should not fly until 24 hours post treatment and asymptomatic.)
The first AASI is deferred to the FAA
For a first-time AASI application for this condition, with all the medical information needed for a determination, the AASI sheet says the examiner must defer and submit all of it to the AMCD or RFS for the initial determination.
Show the FAA's words: good to know, 4
If this is a first-time application for an AASI for the above disease/condition, and the applicant has all the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or RFS for the initial determination.
FAA sources
Every FAA document this page relies on, with the FAA's own date and the date Crosscheck last read it. The documents to print open at the FAA, so they are always the FAA's current ones.
- Open to print: CACI – Bladder Cancer Worksheet, a PDF at the FAA, in a new tab
- Bladder CancerOpen to print: Bladder Cancer, a page at the FAA, in a new tab
Examiner can issue, FAA review
- Open to print: AASI – Bladder Cancer, a page at the FAA, in a new tab
- Open at the FAA: Pilot Information – What a Detailed Clinical Progress Note must contain, a PDF at the FAA, in a new tab
Medication guidance
Medications Crosscheck lists as taken for bladder cancer, each with its own page on what published FAA guidance says about it.
- Maintenance intravesical treatment on the FAA's bladder cancer worksheet
- Maintenance intravesical treatment on the FAA's bladder cancer worksheet
This reports what the FAA has published. It is not medical advice, and it does not say how the FAA or an examiner will decide a case.