If you are at high risk for urethral cancer, you should undergo a complete medical evaluation. Many tests may be needed to know for sure. The most important steps to make a diagnosis of urethral cancer are:
Clinical history and physical exam. The doctor will ask for detailed information about symptoms and personal and family history. During the physical exam, the doctor will look for signs of cancer spread (or metastasis) near the urethra or at distant sites. This may include a rectal exam and, in women, a gynecological exam to help determine if the cancer has spread to the vulva, vagina, uterus, or ovaries.
Laboratory tests. Blood tests may also be done to check the blood cell counts, as well as to evaluate the function of organs such as liver and kidneys.
Urine cytology. A urine sample is collected and examined for abnormal cells.
Cystoscopy. In this test, a thin, lighted tube is used to view the inside of the urethra and the urinary bladder. With this instrument the doctor can determine the exact location and size of the tumor. This procedure is also helpful to guide the doctor during the biopsy to remove a tissue sample.
Biopsy. If the doctor suspects cancer, a small tissue sample may be taken. This is called a biopsy. The tissue sample is examined under a microscope by a doctor, called a pathologist, who specializes in looking for cancer.
More tests may be needed to determine how far the disease has spread (cancer stage):
Computed tomography (CT) scan. A CT scan uses X-rays. In this test, an X-ray beam moves around the body and takes a series of pictures of the body from many angles. These different pictures are then combined by a computer, giving the doctor a very detailed cross section of the body. This test can help to show whether the tumor has spread to organs such as lungs, liver, or lymph nodes in the pelvis or in the abdomen.
Magnetic resonance imaging (MRI).An MRI is a test that uses magnets and radio waves to take pictures of the inside of the body, much like a CT scan. MRIs do not use x-rays. The MRI may be a better test to evaluate the spread of cancer.
Ultrasound. This test uses sound waves to look for abnormalities in the abdominal organs (liver, spleen, kidneys). The sound waves bounce off body parts and send back an image, like sonar on a submarine. A computer then looks at the signals sent back by the sound waves and creates an image of the body using those signals. In women, a special form of ultrasound, called transvaginal ultrasound, can be helpful to see if cancer has spread to the uterus, vagina, or other nearby organs.