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Diagnosing kidney cancer

Diagnosis is the process of finding the underlying cause of a health problem. If cancer is suspected, the healthcare team will confirm if it is present or not, and what type of cancer it is. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis.

 

Diagnostic tests for kidney cancer are usually done when:

  • the symptoms of kidney cancer are present
  • the doctor suspects kidney cancer after talking with a person about their health and completing a physical examination
  • routine tests suggest a problem with the kidney

 

Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

 

Diagnostic tests

Staging and other tests

Medical history and physical examination

Urinalysis

Urine cytology

Blood chemistry tests

Complete blood count (CBC)

Ultrasound

Computed tomography (CT) scan

Magnetic resonance imaging (MRI)

Biopsy

 

Blood chemistry tests

CT scan

Renal angiography

X-ray

Bone scan

MRI

 

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person's family may also help the doctor to diagnose kidney cancer.

 

In taking a medical history, the doctor will ask questions about:

  • a personal history of:
    • smoking
    • use of over-the-counter pain medicines
  • a family history of
    • kidney cancer
    • genetic conditions that may increase the risk of developing kidney cancer
    • other cancers
  • signs and symptoms

 

A physical examination allows the doctor to look for any signs of kidney cancer. During a physical examination, the doctor may:

  • examine the abdomen, back and flank to feel for a lump in the area of the kidneys

 

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Urinalysis

Urinalysis is a test that measures substances, such as electrolytes, hormones and other waste products of metabolism, found in urine. It is one of the many studies that can be done to examine urine.

 

With kidney cancer, a urinalysis is used to check for blood in the urine. Blood is not normally present in urine. Blood in the urine means that there is bleeding into or within the kidneys or urinary tract, possibly because of cancer.

 

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Urine cytology

A urine cytology test looks for abnormal cells in the urine. It may be ordered if blood was found in the urine during a urinalysis.

 

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They are used to diagnose and stage kidney cancer.

  • kidney function tests
    • creatinine
    • urea (blood urea nitrogen, or BUN)
    • calcium
    • phosphorus (phosphate)
  • alkaline phosphatase
  • alanine aminotransferase (ALT)
  • aspartate transaminase (aminotransferase, AST)
  • bilirubin

 

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Complete blood count

A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check for:

  • anemia – from long-term (chronic) bleeding from the kidneys or other parts of the urinary tract
  • an elevated red blood cell count – can be a symptom that the kidneys are producing too much erythropoietin

 

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Ultrasound

Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:

  • determine if a kidney abnormality is a cyst or a tumour
    • A cyst appears full of fluid.
    • A tumour (benign or malignant) appears solid.
  • locate a kidney tumour during a biopsy

 

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • diagnose kidney cancer (including the size, shape and location of the tumour)
  • find out if the tumour has spread to the lymph nodes, blood vessels or other organs
  • locate a kidney tumour during a biopsy

 

CT scan is the most commonly used imaging test in the diagnosis of kidney cancer.

 

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It is used to check if cancer has spread to the major blood vessels of the kidney or to other organs, especially with large kidney tumours (bigger than 7 cm).

 

MRI is not used if a CT scan and other tests clearly show the kidney tumour and how far it has spread. It may not be used in all cancer treatment centres in Canada.

 

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Biopsy

Kidney cancer is not usually diagnosed with a biopsy because imaging tests, such as a computed tomography (CT) scan and ultrasound, usually confirm the diagnosis by the appearance of the tumour.

 

A biopsy may be used to confirm the diagnosis of cancer before treatment is started in people who have small tumours (less than 3 cm) and who are not well enough to have surgery.

 

During a kidney (renal) biopsy, the person will lie on their stomach so that the kidney can be easily reached during the procedure. A local anesthetic is used to freeze the area, or in some situations, the person may be given a general anesthetic. Using ultrasound or CT as a guide, the doctor pushes a needle through the back and into the kidney. Several samples are removed from the kidney and the tumour.

 

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Renal angiography

A renal angiography is used to map the blood vessels in a kidney tumour before surgery. During this procedure, a dye is injected into a vein in the leg. Then a series of x-rays are taken to examine the blood vessels of the kidneys.

 

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X-ray

An x-ray uses small doses of radiation to make an image of the body's structures on film. It is used to see if kidney cancer has spread to the lungs.

 

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Bone scan

A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if kidney cancer has spread to the bone, especially if other test results suggest spread to the bone, such as increased alkaline phosphatase or calcium level.

 

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See a list of questions to ask your doctor about diagnostic tests.

 

References

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