FISH testing

FISH stands for fluorescence in situ hybridisation. It is a test that looks for gene changes in cells. Genes are made of DNA Open a glossary item. They control everything the cell does, including when it grows and reproduces. FISH tests look for specific genes or parts of genes. 

Changes in genes can make the cancer cell:

  • produce particular proteins

  • make far more of the protein than normal

  • stop making a particular protein

If a gene change occurs, the cell may produce too much of a protein or not enough. This can make the cancer cells grow and reproduce more than normal.

Cancer treatment

There are now cancer treatments that target specific proteins. It helps your doctor to know if your cancer has a particular change in its genetic make up. This can tell them whether a particular treatment is likely to work for you. 

Breast cancer

Some breast cancers produce too much of the protein HER2 Open a glossary item because of a change in a gene called HER2/neu. If doctors need to find out more about HER2 levels, they can arrange a FISH test. It can show if the breast cancer is HER2 negative, HER2 positive or HER2 low. 

Your doctor will work out the best treatment for you depending on the results of the test. 

How is FISH testing done?

FISH testing is done by a pathologist. A pathologist is an expert who looks at and identifies cells.

To do a FISH test the pathologist needs some blood or tissue from your cancer. This can be from a biopsy Open a glossary item, a blood sample or from tissue when you had surgery to remove your cancer.

In the laboratory, the pathologist attaches a dye and ultraviolet light to find and count the gene changes. 

How available is FISH testing?

FISH tests are used in several cancers including:

  • breast cancer

  • chronic lymphocytic leukaemia (CLL)

  • acute lymphoblastic leukaemia (ALL)

  • acute myeloid leukaemia (AML)

  • chronic myeloid leukaemia (CML)

  • myeloma

  • Ewing sarcoma

  • lymphoma

  • lung cancer

  • melanoma skin cancer

  • bladder cancer

It's also used for non cancerous conditions such as Prade Willi syndrome and specific infections.

Doctors and researchers are finding out more about genetic changes that affect how cancer grows. FISH tests are an important part of finding more specific information about different cancer types. They can help doctors decide what treatment you need and to check how well treatment is working.  

  • Fluorescence In Situ Hyberidization (FISH). Fact Sheet
    National Human Genome Research Institute, last updated 2020

  • UK recommendations for HER2 assessment in breast cancer: an update

    E A Rakha and others

    Journal of Clinical Pathology, 2023. Volume 76, Issue 4, Pages 217-227

  • Guidelines for cytogenetic investigations into tumours
    R J Hastings and others
    European Journal of Human Genetics, 2016. Volume 24, Issue 1, Pages 6 to 13

  • Fluorescent in situ hybridisation (FISH)

    J van Campen

    NHS England National Genomics Education Programme, Last reviewed February 2025. (Accessed June 2025) 

  • Application of Fluorescence In Situ Hyberidization (FISH) Technique for the Detetction of Genetic Aberration in Medical Science
    Z A Ratan and others
    Cureus, 2017. Volume 9, Issue 6

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk if you would like to see the full list of references we used for this information.

Last reviewed: 
17 Jun 2025
Next review due: 
17 Jun 2028

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