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How is upper tract urothelial cancer diagnosed?

If your doctor thinks you may have UTUC they will take your medical history, perform a physical examination and arrange for you to have a number of tests. If the results of these tests suggest that you may have UTUC, your doctor will refer you to a specialist called a urologist, who will arrange further tests. These may include:

Urine tests – you will be asked to collect a urine sample either at home or at your doctor’s surgery which will be checked for blood and bacteria. This may be a dipstick test (urinalysis) or it may involve sending your urine to a pathology laboratory to be checked. You may also need to collect urine samples over three days to be checked for cancer cells. This test is called urine cytology.

Blood tests – to measure your white blood cells, red blood cells and platelets, and to check your kidney and liver function.

Ultrasound scan – this scan uses soundwaves to create pictures of the inside of your body. You will lie down on an examination table and a gel will be spread over the affected part of your body. A small device called a transducer is moved over the area. The transducer sends out soundwaves that echo when they come across something dense, like an organ or tumour. The images are then projected onto a computer screen. An ultrasound is painless and takes about 15–20 minutes.

CT (computerised tomography), MRI (magnetic resonance imaging) and PET (positron emission tomography) scans – these tests use special machines to scan and create pictures of the inside of your body. Before one of these scans, you may have an injection of dye (called contrast) into one of your veins, which makes the pictures clearer. During the scan, you will need to lie still on an examination table. For a CT scan the table moves in and out of the scanner which is large and round like a doughnut; the scan itself takes about 10 minutes. For an MRI scan the table slides into a large metal tube that is open at both ends; this scan takes about 30–90 minutes. A PET scan involves having an injection of a small amount of radioactive material and then having a special CT scan. All of these scans are painless.

Cystoscopy and ureteroscopy – a cystoscopy involves looking in the bladder while a ureteroscopy involves looking up into the ureter to the kidney. A cystoscopy can usually be performed under a local anaesthetic. It uses a thin, flexible tube with a light and small camera on the end that is inserted into the urethra. This is at the tip of the penis or just above the vagina. A ureteroscopy test is usually performed under a general anaesthetic. First, a cystoscopy is performed then an even thinner tube (ureteroscope) is passed into the bladder then moved into the ureter and renal pelvis. Tissue samples may be removed (biopsy) for further examination under a microscope. For a few days after either test you may see some blood in your urine and feel mild discomfort when urinating.

Finding a specialist

Rare Cancers Australia have a directory of health professionals and cancer services across Australia.

Visit Urological Society of Australia and New Zealand (USANZ) which is the peak membership organisation for urological surgeons and other health professionals working in the field of urology.

Featured resources

Understanding Upper Tract Urothelial Cancer

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Understanding Rare and Less Common Cancers

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This information is reviewed by

This information was last reviewed February 2021 by the following expert content reviewers: the Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group Consumer Advisory Panel; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Dr Tom Ferguson, Medical Oncologist, Fiona Stanley Hospital, Perth, WA; Prof Dickon Hayne, UWA Medical School, The University of Western Australia, and Head, Urology, South Metropolitan Health Service, WA; Steven Jones-Evans, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Dr Carlo Yuen, Urologist, St Vincent’s Hospital, Sydney, NSW.