How Is Kidney Cancer Diagnosed?

Kidney cancer is usually asymptomatic in earlier stages.

Kidney cancer is usually asymptomatic in earlier stages. The tumor is usually found when a patient undergoes medical tests for another reason. A doctor may order the following tests to confirm the diagnosis.

Physical exam and history:

• A doctor may examine the body to check general signs of any ill health.
• They may also check for lumps or anything else that seems unusual.
• They may ask the patient about their health habits, past illnesses, family illnesses and treatments.

Blood tests:

• Chemical tests of the blood may detect findings associated with kidney cancer. The doctor will check blood samples to look for certain substances released into the blood by the organs. If the amounts of these substances are higher or lower than normal, it is a sign of a disease. A high creatinine level may often point to a kidney problem.
• Blood tests also give the idea of how the body is functioning and if there are any signs of cancer such as anemia.
• The doctor checks a sample of blood to measure the enzymes released by the liver. Unusual levels may be a sign that cancer has spread to the liver.

Urinalysis (Urine test):

• A common sign of kidney cancer is blood in the urine. Remember that blood in the urine can be caused by conditions other than cancer as well.
• This test can also detect other abnormalities in the urine such as protein and urine infections.
• A novel molecule called human kidney injury molecule-1 (KIM-1) is a sensitive and specific biomarker for identifying kidney injuries. Urine levels of KIM-1 are elevated in patients with kidney failure and major types of kidney tumors. However, KIM-1 is still under investigation and not yet approved by the U.S. Food and Drug Administration (FDA).

Ultrasound exam:

• The doctor may first take an image of the kidneys and organs using an ultrasound. Here, high-energy sound waves (ultrasound) bounce off the internal tissues or organs and make images.
• If cancer or a lump is present, it may be detected in a routine ultrasound examination.

Intravenous pyelogram (IVP):

• The doctor takes a series of X-rays of the kidneys, ureters and bladder to see if cancer is found there.
• They inject a contrast dye through a vein. The dye moves through these organs, and the doctor takes X-rays to look for blockages.

Computed tomography (CT scan):

• Using this procedure, the doctor can get a series of detailed pictures of the inside of the body from different angles.
• These pictures are produced by a computer linked to an X-ray machine.
• A dye is used to help see the organs or tissues more clearly.
• CT scan is a reliable tool to check the extent of the spread of kidney cancer.

Magnetic resonance imaging (MRI):

• This imaging exam uses a magnet, radio waves and a computer to produce detailed pictures of the organs.
• The doctor will get a clearer image of abnormal growths through these images.

Biopsy:

• A biopsy involves removing the cells or tissues of an organ and studying them under a microscope.
• A pathologist views the sample under a microscope.
• For renal cell cancer, the pathologist inserts a thin needle into the tumor and removes a sample of the tissue for a biopsy.

Cystoscopy:

• If a patient has blood in their urine, the doctor may order for cystoscopy.
• This is a test that lets the doctor look into the bladder and urethra using a telescope with a lens and a light.
• The doctor uses this test to see if the blood in the urine is coming from the bladder or urethra.

Bone scan:

• The doctor uses a bone scan to see if cancer has spread to the bones.
• They inject a small and harmless amount of radioactive material into a vein.
• The substance slowly moves through the blood into the bones.
• It particularly goes into the cancer cells.
• After three to four hours, the doctor performs a scan that detects radioactivity.
• If cancer has spread to the bones, it will show up as a large amount of radioactivity.

Positron emission tomography (PET) scan:

• A PET scan is a specialized scan that uses radioactivity to show the chemical function of an organ or a tissue.
• It can detect cancer even before it is seen on other types of scans.
• A PET scan can create an image of the organ in which cancer is suspected.
• This means that it can show if (and where) cancer is spreading.
• A PET scan can also be used to see if tumors are benign (not cancer) or malignant (cancer) and to tell the difference between a tumor and scar tissue.

Majority of cases of kidney cancer are usually confirmed with a CT or an MRI scan because it gives enough information for the doctor to recommend surgery or other treatments for kidney cancer.

What are the possible treatment options for kidney cancer?

Treatment for kidney cancer depends on many factors including the stage of cancer and location. Often, the doctor recommends a combination of therapies. These may include

Surgery:

• The doctor performs a laparoscopic or robotic nephrectomy (partial or radical) by inserting telescopic instruments in the abdomen through small incisions.
• Partial nephrectomy involves removal of part of the kidney with the tumor.
• Radical nephrectomy involves removal of the whole kidney and sometimes the adrenal gland, tissue around the kidney and surrounding lymph nodes.
• The doctor performs an open nephrectomy (partial or radical) through a flank or abdominal incision.
• Laparoscopic nephrectomy involves removal of all or part of the kidney through a series of small incisions in the abdomen.
• Robot-assisted laparoscopic nephroureterectomy involves removal of the entire kidney and ureter down to the bladder by inserting telescopic instruments in the abdomen through small incisions.

Radiation therapy:

• Radiation cannot cure kidney cancer. However, it can alleviate symptoms such as bone pain. It may be used alone or in combination with other therapies.

Targeted therapy:

• It involves drugs that attack specific cancer cells, slowing down growth. It treats advanced kidney cancer.

Immunotherapy:

• Immunotherapy or biological therapy uses the body's own immune system to fight cancer.