Table of ContentsView AllTable of ContentsSelf Checks/At-Home TestingLabs and TestsImagingDifferential DiagnosisStaging Kidney CancerFrequently Asked QuestionsNext in Kidney Cancer GuideIs Kidney Cancer Curable? Understanding the Odds
Table of ContentsView All
View All
Table of Contents
Self Checks/At-Home Testing
Labs and Tests
Imaging
Differential Diagnosis
Staging Kidney Cancer
Frequently Asked Questions
Next in Kidney Cancer Guide
Kidney cancer (renal cell carcinoma)is usually diagnosed using a combination ofultrasound, CT, and MRI scans, along with a careful history, physical exam, blood tests, and urine tests. Once a cancer is diagnosed, the tumor needs to be carefully staged in order to determine the most appropriate treatments.
Going through the diagnostic process can be stressful—you may feel fear and anxiety. Knowing what to expect and how to cope with the wait time and results may help ease some of the emotions.
Kidney cancercan’t be diagnosed at home, but since there is not currently a screening test, having an awareness of thepossible signs and symptomsof the disease is something everyone can do.
In particular, if you note that you have blood in your urine (any amount), flank pain, a flank mass, feel tired or have lost your appetite, or lose weight without trying, make sure to see your healthcare provider.
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An evaluation for kidney cancer often begins with a careful history, looking for risk factors for the disease, a physical exam, and laboratory tests.
Physical Exam
A physical exam is done with special attention given to checking for a mass in the abdomen, flank, or back, as well as checking blood pressure.The kidneys play an important role in regulating blood pressure, and tumors may result in persistenthigh blood pressurethat is sometimes dangerously high (malignant hypertension).
An exam also includes an evaluation of the genitalia in males. Kidney cancer is unique in that it may cause a varicocele, an enlarged vein (varicose vein) in the scrotum or testicle.Unlike many causes of a varicocele, those due to kidney cancer do not go away when a man lies down.
Lab Tests
The diagnostic work-up of a possible kidney cancer often begins with aurinalysis, a test done not to only to look for blood in your urine, but signs of infection, protein, and more.Roughly half of people with kidney cancer will have some amount of blood in their urine.
Acomplete blood count(CBC) is an important test, asanemia(a low red blood cell count) is the most common initial sign of the disease. Kidney function tests are also important, although these may be normal.
Kidney cancer is also unique in that it can cause elevations in liver function tests, even without the cancer spreading to the liver. This sign is one of theparaneoplastic syndromesthat can occur when these tumor cells secrete substances or hormones.Paraneoplastic signs may also include an elevated calcium level in the blood (hypercalcemia), though this may also occur when the cancer spreads to bones.
A number of different imaging modalities may be used for both the diagnosis and staging of kidney cancer.
Ultrasound
Ultrasound uses sound waves to provide a picture of structures in the abdomen.It is often the first test done and is particularly helpful in differentiating simple cysts (which are almost always benign), from solid tumors or solid tumors with cystic parts.
What Is Cystic Renal Cell Carcinoma?
CT Scan
A CT scan is usually done first without contrast, and then with a radiocontrast dye. The dye can sometimes pose concern for people who have kidney dysfunction, in which case a different imaging test may be used.
CT’s are an excellent test for characterizing kidney cancers but are frequently unable to determine if the cancer has spread into the renal vein, the large vein exiting the kidney that joins with the inferior vena cava (the large vein that brings blood from the lower body back to the heart).
MRI Scan
AnMRI scanuses magnetic imaging instead of X-ray technology to create a picture of structures in the abdomen. In it particularly helpful for defining “soft tissue” abnormalities. In general, a CT scan is a better test for evaluating kidney cancer, but an MRI may be needed for those who have abnormal kidney function tests or who have an allergy to contrast dye.
An MRI of the brain may be done to look for evidence ofmetastases(spread) of the cancer to the brain, the third most common location to which kidney cancer spreads.
PET Scan
PET scansare used frequently in cancer diagnosis, but much less so in the diagnosis of kidney cancer.During a PET scan, a small amount of radioactive sugar is injected into the body and images (usually combined with CT) are taken after the sugar has had time to be absorbed.
Unlike CT and MRI, it is considered a functional test rather than a structural test and may be useful in distinguishing areas of active tumor growth from areas such as scar tissue.
Intravenous Pyelogram (IVP)
An IVPis a test in which dye is injected into a vein.The kidneys then take up this dye, allowing radiologists to view the kidneys, especially the renal pelvis.
IVPs are done infrequently in the diagnosis of kidney cancer but may be used for urothelial cell cancers (transitional cell cancers such ascancers of the bladderand ureter than can sometimes include the central portion of the kidneys, the renal pelvis).
Renal Angiography
Angiographyis often done in combination with a CT scan and involves injecting a dye into the renal artery to define the blood vessels of the kidney.This test is sometimes used to help plan for surgery for a tumor.
Cystoscopy and Nephro-Ureteroscopy
These tests involved inserting a lighted catheter into the bladder, through the ureter, and up to the renal pelvis (the “center” of the kidney).It is used primarily if there is also a mass in the bladder or ureter, such as transitional cell carcinoma.
Biopsy
While a biopsy is essential in diagnosing many cancers, it is not often necessary for diagnosing kidney cancer.In addition, there is a risk with fine needle biopsies (biopsies done with a thin needle inserted through the skin and into the kidney) that the procedure could “seed” the tumor (spread the tumor alone the pathway of the needle).
Samples of a tumor are important for planning treatment, such as with targeted therapies, but are most often obtained during surgery instead of a biopsy.
Tests for Metastases
Kidney cancer can spread either through the bloodstream or through the lymphatic vessels, and the most common sites of metastases are the lungs, bones, and brain, in that order.A chest X-ray (or chest CT) may be done to look forlung metastases.
Either abone scanor PET scan can determine if bone metastases are present.An MRI of the brain is the best test to look for brain metastases.
Unlike many cancers, there are relatively few causes of a mass in the kidney. The differential diagnosis, however, can be more difficult when a small mass is found in the kidney, usually incidentally when a test is done for another reason.
Other possible causes of a renal mass include:
Staging a kidney cancer is usually done after surgery and combines the results of imaging tests along with characteristics of tumor which is sent to pathology after surgery, as well as findings during surgery.
Tumor Grade
Kidney cancers are given a grade of 1 to 4, called the Fuhrman grade, that is a measure of the aggressiveness of a tumor.
A grade of 1 is used to describe tumors that are the least aggressive and have cells that are very differentiated (look the most like normal kidney cells).In contrast, a grade of 4 is given to describe the most aggressive appearing tumors, those that are very undifferentiated and look very different from normal kidney cells.
TNM Staging
Kidney tumors are also evaluated using something called the TNM system. This can be confusing at first but is much easier to understand if we define these letters and what the numbers mean.
Tx (or Nx or Mx) means that the tumor (or nodes or metastases) cannot be assessed. T0 means there is no evidence of a primary tumor and is used if kidney metastases are found, but the primary tumor cannot be located.
Stages
Using the letters above, kidney cancers are then divided into 4 stages:
Recurrent Kidney Cancer
Recurrent kidney cancer refers to any cancer which has come back, whether within the kidney, in surrounding tissues, in lymph nodes, or in distant sites.
All the diagnostic tests performed will help your healthcare provider accurately stage your tumor. Based on the results, he or she will be better able to choose atreatmenttailored to your situation.
Is Kidney Cancer Curable? Understanding the Odds
Frequently Asked QuestionsNo. A blood test can’t be used to diagnose kidney cancer. However, your healthcare provider will runblood teststo check red blood cell levels and measure liver function, since kidney cancer can interfere with these.If you have time before starting treatment, it may be best to get asecond opinionfor kidney cancer or any type of cancer.This is recommended especially if:Your healthcare provider is not an expert in kidney cancerYou’ve been diagnosed with rare sarcomasYour insurance company requires itThere’s uncertainty about the stage of your cancerLearn MoreIs Kidney Cancer Curable?Not usually. Imaging tests often provide enough information to determine the stage and best way to treat kidney cancer.Taking a sample may be necessary in some instances, or a biopsy ofmetastaticsites may be needed.
No. A blood test can’t be used to diagnose kidney cancer. However, your healthcare provider will runblood teststo check red blood cell levels and measure liver function, since kidney cancer can interfere with these.
If you have time before starting treatment, it may be best to get asecond opinionfor kidney cancer or any type of cancer.This is recommended especially if:Your healthcare provider is not an expert in kidney cancerYou’ve been diagnosed with rare sarcomasYour insurance company requires itThere’s uncertainty about the stage of your cancerLearn MoreIs Kidney Cancer Curable?
If you have time before starting treatment, it may be best to get asecond opinionfor kidney cancer or any type of cancer.This is recommended especially if:Your healthcare provider is not an expert in kidney cancerYou’ve been diagnosed with rare sarcomasYour insurance company requires itThere’s uncertainty about the stage of your cancer
If you have time before starting treatment, it may be best to get asecond opinionfor kidney cancer or any type of cancer.This is recommended especially if:
Learn MoreIs Kidney Cancer Curable?
Not usually. Imaging tests often provide enough information to determine the stage and best way to treat kidney cancer.Taking a sample may be necessary in some instances, or a biopsy ofmetastaticsites may be needed.
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