Diagnosing kidney cancer

Saturday 1 November, 2014

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On this page: Urine and blood tests | Internal examination (cystoscopy) | Imaging tests | Tissue biopsy | Staging and grading | Prognosis | Which health professionals will I see? | Key points


About one in three kidney cancers are advanced at the time of diagnosis. This is because people usually don’t have noticeable symptoms even though the cancer has been present for some time.

If your doctor suspects you have kidney cancer, you will have some of the following tests to confirm the diagnosis and show if cancer has spread to other parts of the body. You are unlikely to need all of these tests.

There are four categories of tests: blood and urine tests, internal examination (cystoscopy), imaging (such as an ultrasound), and tissue sampling (biopsy).

It may take up to a week to receive your test results. You might feel anxious during this time. It could be helpful to discuss your feelings with someone, such as a close friend or relative. You can also call Cancer Council 13 11 20 for information and support.

Urine and blood tests

Urine test

The most common sign of kidney cancer is blood in the urine (haematuria). Doctors will sometimes request a urine test so they can look for traces of blood and other abnormalities, such as proteins, that can’t be seen with the naked eye. However, blood in the urine can be caused by conditions other than cancer.

Blood tests

The doctor will ask for a blood sample to check for changes that could be caused by kidney cancer. A blood count identifies the number of different types of blood cells present.

Too few or too many red blood cells can be a sign of kidney cancer. High calcium levels, high levels of certain substances called enzymes or other chemicals, and changes in salt levels might also be found in people with kidney cancer. In most cases, blood test results are normal and the doctor will do further tests.

Internal examination (cystoscopy)

If you have blood in your urine, your doctor might want to look inside your bladder to see where the blood is coming from. This procedure is called a cystoscopy. You will be given a general or local anaesthetic so you are not in pain. The doctor will pass a tiny telescope (cystoscope) through the urethra and into the bladder to check for bleeding, tumours or other abnormalities.

If necessary, the urologist can also examine the ureters by using a fine telescope (ureteroscope) or perform an x-ray after pushing dye into the ureters. These tests are done to rule out other types of cancer such as urothelial carcinoma.

A cystoscopy may feel uncomfortable, but should not cause pain. For a few days afterwards, you may feel a burning sensation when passing urine or notice blood in your urine. This is normal. Let your doctor know if the blood lasts longer than a few days.

You might not need a cystoscopy if you have had an ultrasound that has shown a tumour on your kidney – see below. 

Imaging tests

You will usually have at least one of the tests described below. If the doctor needs further information to make a diagnosis or to see if the cancer has spread, you might have more than one scan.

Ultrasound

In an ultrasound, soundwaves are used to produce pictures of your internal organs. These might show if a tumour is present.

Before the test, you might be asked to drink fluids so your bladder is full. While you’re lying down, a gel is spread over your abdomen or back and a small device called a transducer is passed over the area. The device sends out soundwaves that echo when they encounter something dense, like an organ or tumour. A computer creates a picture from these echoes.

The ultrasound is painless and takes about 15–20 minutes.

CT scan

A CT (computerised tomography) scan is a procedure that uses x-ray beams to take pictures of the inside of your body. Unlike a standard x-ray, which takes a single picture, a CT scan compiles many pictures into one complete picture of an area of your body.

CT scans are useful for identifying any tumours in the kidneys and checking whether cancer has spread to other organs and tissues. The scan can provide information about the size, shape and position of a tumour. It also helps identify enlarged lymph nodes that might contain cancer.

You will probably have an injection of a dye (called contrast) into one of your veins before the scan. This dye helps make the scan pictures clearer. It might make you feel flushed and hot for a few minutes. Rarely, more serious reactions occur, such as breathing difficulties or low blood pressure. Let the person doing the scan know if you feel unwell.

You will need to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly moves around you.

This scan will take about 30–40 minutes. Most people are able to go home as soon as the scan is over. 

The dye used in a CT scan usually contains iodine. If you’re allergic to iodine or dyes from previous scans, let the person performing the scan know in advance. You should also tell the doctor if you’re diabetic, have kidney disease or are pregnant.

MRI scan

An MRI (magnetic resonance imaging) scan uses a combination of magnetism and radio waves to build up detailed cross-section pictures of your body.

Sometimes an MRI scan is ordered because it can provide different details than a CT scan can, but only a small percentage of people with kidney cancer need this test. You might have an MRI if the doctor wants to check whether the cancer has gone into the renal vein or spread to the spinal cord.

The MRI scanner sometimes makes people feel anxious or afraid of being in a confined space (claustrophobic). If you feel uncomfortable, tell the person performing the scan. You might be able to have medication to help you relax. 

As with a CT scan, a contrast medium might be injected into your veins before a scan. Let the doctor know if you have any metallic objects, such as a pacemaker, in your body, as these can sometimes affect the image.

During the scan, you will lie on an examination table inside a metal cylinder – a large magnet – that is open at both ends. The scanner can be noisy at times.

The MRI scan might take up to an hour. You will probably be able to go home as soon as it is done. 

"I had various scans when I was diagnosed with primary kidney cancer. I found the MRI frightening, particularly going into the cylinder headfirst and having to hold my breath. I found counting to myself helpful. It made me feel more in control." – George
Chest x-ray

A chest x-ray is used to check for problems in the organs and bones of the chest. If cancer has already been diagnosed, a chest x-ray can show whether the cancer has spread to your lungs or ribs. The x-ray takes only a few minutes and is painless and safe.

Radioisotope bone scan

A radioisotope scan is another way to see if any cancer cells have spread to the bones. You might have this test if you have a very large tumour or advanced kidney cancer. The scan can also help the doctor determine how well you are responding to treatment.

A small amount of radioactive substance is injected into a vein, usually in your arm. You will need to wait while the substance moves through your bloodstream to your bones, which can take about 3–4 hours.

Your body will be scanned with a machine that detects radioactivity. A larger amount of radioactivity will show up in any areas of bone affected by cancer cells. Radioisotope bone scans generally do not cause any side effects.

Exposure to radiation

The amount of radioactive substance used for a radioisotope bone scan is small. The radiation disappears from your body within a few hours.

However, tell your doctor if you are pregnant, as it might not be safe for you to have this scan.

After the scan, you should drink plenty of fluids and avoid contact with young children and pregnant women for the rest of the day.

If you need more details, ask your hospital for advice.

Tissue biopsy

A biopsy is when doctors remove fluid or cells from the body so that the tissue can be examined under a microscope to see if there have been any changes in the cells.

For kidney cancer, a tissue biopsy is not often used for diagnosis. This is because other tests will usually give the doctor enough information to recommend a type of treatment. However, a biopsy might be recommended:

  • if there is a possibility that the tumour in the kidney might not be the primary cancer but has spread from elsewhere in the body (metastasis)
  • when the doctor suspects the tumour is not cancer (benign), and might not need aggressive treatment but instead could be kept under surveillance (see treatment for early kidney cancer).
A biopsy can usually identify the type of cancer cells in the body. You will have either a needle core biopsy or a fine needle aspiration.
  • Needle core biopsy: A sample of tissue is removed from the kidney with a needle. Local anaesthetic is used to numb the area. The biopsy usually takes about 30 minutes to perform.
  • Fine needle aspiration biopsy (FNA): A thin needle is inserted through the skin into the kidney to remove either fluid or cells. It is a quick procedure, which is usually done without anaesthetic. An FNA is not common for kidney cancer, as more tissue is usually required than can be obtained with this technique.

Staging and grading kidney cancer

The tests used to diagnose kidney cancer show how far the cancer has spread (the stage), and how abnormal the cancer cells look and how fast they’ll probably grow (the grade). Knowing the stage and grade of the cancer helps doctors plan the best treatment for you. 
Staging: TNM system
T (Tumour) 1-4 Indicates the size of the tumour and whether it has spread to nearby tissues. A higher number after the T means that it is larger, or has spread to tissues surrounding the kidney.
N (Nodes) 0-2 Indicates whether the lymph nodes are affected. Higher numbers are used when more than one group of nodes is affected by the cancer.
M (Metastatis) 0-1 Indicates whether the cancer has spread to more distant parts of the body. 0 means that the cancer has not spread; 1 means the cancer has spread.

Grading: Fuhrman system
Grade 1
The cancer cells look fairly normal, are probably growing slowly and are less likely to spread.
Grade 2
The cancer cells appear slightly abnormal and might grow more rapidly.
Grade 3
Most cells appear abnormal and the cancer might grow quickly.
Grade 4
No cancer cells look normal and they're more likely to grow and spread rapidly.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for any doctor to predict the exact course of your disease. Instead, your doctor can give you an idea about common issues that affect people with kidney cancer.

In most cases, the earlier kidney cancer is diagnosed, the better the outcome. If the cancer is discovered after it has spread to other parts of the body, it will probably be more difficult to treat successfully.

People who are able to have surgery to remove the cancer have a higher survival rate. However, other factors such as your age, general fitness and medical history also affect prognosis. 

Which health professionals will I see?

Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, such as a urologist, who will arrange further tests and advise you about treatment options.

You will also be cared for by a range of other health professionals, who specialise in different aspects of your treatment. This multidisciplinary team will probably include the professionals described in the table below.

Health professional
Role
urologist
a doctor who specialises in treating diseases of the urinary system 
nephrologist
a doctor who specialises in caring for people with conditions that cause kidney (renal) impairment or failure 
medical oncologist
prescribes and coordinates targeted therapies and chemotherapy and helps to manage your overall health
radiation oncologist
prescribes and coordinates the course of radiotherapy 
nurses
administer drugs and support you through all stages of treatment 
cancer care coordinator supports patients and families throughout treatment and liaises with other staff 
dietitian
recommends an eating plan to follow while you are in treatment and recovery  
social worker, counsellor, physiotherapist and occupational therapist link you to support services and help with emotional, physical or practical issues

Key points

  • Kidney cancer often doesn’t produce any symptoms, but sometimes people have urinary problems or back pain.
  • Cancer might be present for some time before diagnosis. Some kidney cancers have already advanced by the time they are diagnosed.
  • Several types of tests are used to diagnose kidney cancer and to see if it has spread. These include blood and urine tests, internal examination, imaging tests and, occasionally, tissue sampling (biopsy).
  • Tests show what type of kidney cancer you have, as well as its stage and grade.
  • The stage of the cancer shows how far the cancer has spread in the body. The TNM system is used for staging. This stands for Tumour, Nodes, Metastasis.
  • The grade of the cancer shows how abnormal the cancer cells appear. The Fuhrman system is used for grading (1–4).
  • Knowing the stage and the grade helps doctors plan the best treatment for you.
  • Your prognosis is the expected outcome of the disease, based on the type of cancer you have, your treatment options and other factors such as your age, medical history and fitness. Your doctor can discuss your prognosis with you.
  • You will be cared for by various health professionals who work together as a team. This will probably include a urologist or nephrologist, nurses and other allied health professionals.

Reviewed by: A/Prof Manish Patel, Urological Cancer Surgeon, University of Sydney and Westmead and Macquarie University Hospitals, NSW; Prof Ian Davis, Professor of Medicine and Head of Eastern Health Clinical School, Faculty of Medicine and Nursing and Health Science, Monash University, and Senior Medical Oncologist, Eastern Health, VIC; Karen Hall, Nurse Counsellor, Helpline, Cancer Council SA, and Clinical Nurse, Oncology/Haematology Inpatient Unit, Flinders Medical Centre, SA; Julie McGirr, Cancer Helpline Nurse, Cancer Council Victoria, VIC; and Jodie Turpin, Consumer.

Updated: 01 Nov, 2014