Medical History and Physical Exam
If your primary care doctor feels that you should see an expert, you will be referred to a urologist. The urologist will ask a variety of questions about your health history and will check your body with a variety of tests. He or she will feel your belly, sides and back for lumps, and will order blood tests.
A microscopic exam of cells in the urine (cytology) can help find an upper urinary tract cancer. Sometimes normal urine from the other kidney can water down a sample, making cancerous cells hard to find. If your doctor suspects cancer or cannot find the source of blood in the urine, he or she may order imaging tests.
Ultrasound and CT (computerized tomography) scans are painless, nonsurgical ways to check the urinary tract. But while CT scans can show stones in the kidney and ureter, they are less useful in showing tumors. To see tumors more clearly, the doctor may use a contrast dye with the CT scan. To check whether the cancer has spread to other organs, MRI (magnetic resonance imaging) may also be helpful. Adding a retrograde X-ray (X-ray using a special dye) may be needed if you have poor kidney function.
If the source of bleeding is still in doubt, your doctor may order cystoscopy. A cystoscope uses a special fiber optic tool (like a camera lens) to look through the urethra into the bladder and urinary tract.
If the urologist needs more information, he or she may do a direct visual inspection of your upper urinary tract. This is usually done while you are under anesthesia. An endoscope (a scope with a light attached) is inserted through the urethra into the bladder. It is then moved up to see inside the ureter and renal pelvis. If needed, the doctor will remove a sample of tissue to help in the diagnosis (a biopsy).
Imaging for Metastases
If the urologist has a confirmed cancer diagnosis, he or she will check to see if it has spread. If urinary tract cancer cells are found in other sites, it is called metastatic cancer.
Tests to see if the cancer has spread to common sites include:
- CT scan (of the abdomen, pelvis, and nearby lymph nodes and organs)
- chest X-ray (to look at the lungs)
- bone scan (to look at the skeleton)