This section explains the tests and investigations that may be used during a diagnostic workup for a suspected cancer. When deciding what tests to refer you for, your healthcare team will refer to a diagnostic guideline, known as a diagnostic workup. The purpose of this workup is to try to determine whether a cancer is present, where it started, and how far it may have spread as quickly as possible, avoiding unnecessary and repetitive testing. The workup is then used to guide your clinicians next steps, including referral to specialists or further testing if needed.
Typically, a minimum diagnostic workup will include:
Your doctor will conduct a physical examination of your body, paying close attention to the areas of your body where you are experiencing symptoms. This can include looking for lumps on your body, feeling for swollen lymph nodes or anything that might be unusual.
Your doctor will also have a discussion with you about your health history and your family history. This can include:
Blood tests check the number of white blood cells, red blood cells and platelets in your blood. This is usually referred to as a complete blood count (CBC), full blood count (FBC), or full blood examination (FBE). They can also check the health of your kidneys and your liver.
X-rays deliver low-energy beams of radiation to create images of parts of the body to produce the pictures. X-ray beams are absorbed differently by structures in the body, such as bones that absorb radiation easily (appearing white in the picture) or soft tissues like organs that don’t absorb radiation as easily and will appear gray.
How long does it take?
10-30 minutes.
What happens?
Some X-rays use dye (contrast) to improve the image and make certain structures easier to see. Depending on what part of the body is being x-rayed, you might be asked to lie, sit or stand. You will hold still in front of or on a machine while the images are taken.
Considerations:
The procedure is painless with only a small dose of radiation. The contrast dye is generally very safe and reactions are uncommon; however, people with diabetes and kidney disease should inform their doctor as they will have a slightly greater risk of reaction.
A CT scan uses X-ray beams and a computer to create detailed pictures of the inside of the body. The scanner is large and shaped like a doughnut. CT scans will provide more detail than an X-ray as it takes dozens to hundreds of images of your body. This provides a clearer image of soft tissues in the body, which don’t always show up on a regular X-ray, and also shows organs and other structures that overlap or are hidden.
How long does it take?
30-60 minutes (mostly due to preparation).
What happens?
Before the scan, you may be given a drink or injected with a dye (contrast) to highlight certain structures in your body. This will make the images clearer. You will usually lie still on a table that moves into the scanner. It is important to lie still as movement could cause blurry or less clear images.
Considerations:
The procedure is painless; however, the dye can make you feel hot or flushed and leave a bitter taste in your mouth. There is a small risk of having an allergy-like reaction to the dye, such as a rash, itchiness, nausea, sweating or difficulty breathing. If you know that you have an allergy to the dye or contrast, or if you are diabetic or have some known kidney issue, inform your doctor. You should also notify your doctor if you are pregnant (or think you may be) as CT scans use slightly higher levels of radiation than x-rays.
An x-ray machine that is designed only for mammograms will use low-dose x-ray beams to create an image of the inside of the breast.
How long does it take?
10-30 minutes.
What happens?
You will stand in front of an X-ray machine that is specially designed for mammograms. Your breast is placed between two x-ray plates, one at a time, which will press together firmly to spread the tissue so a clear image can be taken. This also prevents movement so the image does not become blurred. Usually, two different views are taken of each breast. During the brief period when you are exposed to the x-ray beams, you will be asked to stand still and hold your breath.
Considerations:
The procedure can be uncomfortable when the x-ray plates are pressed together. If the discomfort becomes too much, notify the technologist (the person performing the procedure). You should notify your doctor if you are pregnant (or believe you are) or breastfeeding.
A biopsy is a procedure to obtain a small amount of tissue for testing, with the overall purpose of identifying the type of cancer and, if possible, the original location of the cancer. This may help to guide your doctors in making a diagnosis and choosing the best treatment option. However, if the cancer is too hard to reach or if you are too unwell for the procedure, your doctor might decide against performing a biopsy.
Biopsy Methods
A biopsy sample can be taken as a:
Depending on the method, you will have local anaesthesia to numb the area or general anaesthesia to make you unconscious during the procedure.
Role of the Pathologist in getting a diagnosis
After you have a biopsy, it will be sent to a laboratory for testing. The sample of tissue will be looked at under a microscope by a specialist doctor called a pathologist. A pathologist specialises in the diagnosis of disease based on examination of tissues and fluids removed from the body. Upon examination, the pathologist determines if the tissue sample contains normal, pre-cancerous or cancerous cells and then writes a report on their findings (pathology report).
Watch and listen to a pathologist explain their role in getting a diagnosis:
The pathologist will aim to identify the cancer type present in the biopsy sample. This will help identify the original location of the cancer, and/or identify cells which indicate the presence of a secondary cancer. This may help guide diagnosis and treatment options.
Watch and listen to a pathologist explain their role in interpreting biopsy results:
Sometimes, the primary cancer is not easily recognisable. These cells may have become so abnormal that it is difficult to identify where they came from. These cells are called poorly differentiated or undifferentiated. Further testing may be required, such as immunohistochemistry, where the pathologist uses special stains to locate specific proteins that are linked to known cancer types (e.g., adenocarcinoma, squamous cell carcinoma).
Your clinician may request further testing to reach a diagnosis. Some tests that you may be referred for are outlined below:
Urine tests assess the health of the kidneys and the bladder by looking for any blood or abnormal cells that are present. In some cases, blood and urine tests may also be able to focus on a protein that could help diagnose a blood cancer called myeloma.
Tumour markers might suggest certain types of cancer. Cancers can release certain chemicals into the body called tumour markers that can be produced by one or several types of cancer. High levels can be found in the blood, urine or other bodily fluids of some people with cancer.
Examples of tumour markers and their associated types of cancer:
PET scans use a low-dose radioactive solution to measure cell activity in different parts of the body. The one most commonly used is fluorodeoxyglucose (FDG) which is a simple sugar (glucose) that has been made radioactive. This means that it will give off energy in the body to be seen by the scanner. Cancer cells grow quickly, and as such, need a lot of energy (or a lot of sugar). The increased amount of sugar needed in these areas will show up as 'hot spots'.
About 2 hours.
You will be asked to remove anything metal from your body as it interferes with the images of the scanner. You are injected in the arm with a small amount of the radioactive solution, and wait 30-90 minutes to allow the solution to spread through your body. You will be lying down, usually on your back, on a couch while it moves backwards and forwards in the scanner. The scanner is large and doughnut shaped. As you move through the scanner, it will take pictures of your body.
You need to notify your doctor if you are pregnant or are breastfeeding. The specialist will also tell you to avoid children and pregnant women for a few hours after the scan. It is very rare to have an allergic reaction to the radioactive solution. The solution will leave your body in your urine within a few hours.
A bone scan will look for changes in your bones, using a radioactive tracer (dye) injected into your bloodstream. It can look at one particular joint or bone, but it is more usual for the entire body to be scanned for cancer patients.
The test takes between 30-60 minutes, but you will be required to be at the hospital for several hours.
You are injected in the arm with a small amount of radioactive dye. You will then wait 2-3 hours for it to move through your bloodstream and collect in your bones. The dye tends to collect more in areas where the bone is breaking down or repairing itself and will appear darker on the scan than the other bones. You will lie down on a couch and must keep very still while going through the scanner. A large camera connected to an arm-like device will scan you and pick up on the radioactivity.
If you are pregnant or breastfeeding, notify your doctor and the specialist conducting the scan. The dye leaves your body through your urine after a few hours and you will be told to avoid children and pregnant women for a number of hours.
An MRI scan uses a magnet and radio waves to take detailed pictures of a particular area inside your body.
30-90 minutes
You may be injected with a dye (contrast) depending on the scan you are getting to help the tissues show up clearer on the image. You will lie down on a table and be given earplugs or headphones as the MRI scanner is very noisy. You will also be given a buzzer so you can talk to the specialist who is in a different room whenever you press the button. The scanner is a narrow metal cylinder that is open at both ends. During the scan, the table will move in and out of the tunnel. Depending on the scan, you might have leads (wires or stickers) placed on your chest to monitor your heartbeat, a plastic tube attached to your finer to monitor your breathing, or a needle inserted into a vein if any medicine is needed. The part of the body that is being scanned will be gently secured so that the images collected are clear.
If you might be pregnant, have kidney problems, or do not like closed spaces, you should talk to your doctor. If you feel anxious in closed spaces, doctors may give you some medicine to keep you calm. If there are any metallic objects in your body, such as a pacemaker, you will not be able to have an MRI - notify your doctor. An allergic reaction to the dye (contrast) is very rare, but any reactions are usually mild.
This test combines both a PET scan and a CT scan and will provide more detailed information about the cancer. See above for information about PET scans and CT scans.
About 2 hours.
Genomic testing may be available through clinical trials or other options if you’re eligible. If you have questions about genomic testing, please speak to your healthcare team.
Watch and listen to a genomics specialist explain the role of genomic testing in diagnosis:
Here are the links to other information pages to learn more. You may also use the quick links on the right side of the page to navigate.
Investigations for a suspected cancer can lead to various diagnostic outcomes. To learn more about the different types of diagnosis, click here.
