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Many kidney cancers are found by chance during imaging tests given for other health problems. Other times, testing is started when a person has signs or symptoms of kidney cancer. This article describes the tests for kidney cancer is first suspected or found. These tests are used to find and confirm (diagnose) kidney cancer and help plan treatment. It may also help you know what to expect during testing.
1. General Health Tests
a. Medical History
Before and after cancer treatment, your doctor will assess your medical history. Your medical history includes any health events in your life and any medications you’ve taken. Your doctor will ask about any symptoms and health conditions that you have had. This information may affect which cancer treatment is best for you. It may help to make a list of old and new medications while at home to bring to your doctor’s office.
b. Family History
Some health conditions can run in families. So, your doctor may ask about the medical history of your blood relatives. It’s important to know who in your family has had what diseases. It’s also important
to know at what ages the diseases started. This information is called a family history.
Kidney cancer often occurs for unknown reasons. But, some people have genetic health conditions that increase the risk for kidney cancer. Genetic means that it is passed down from parent to child through genes. One example is VHL (von Hippel-Lindau) disease, also called VHL syndrome. This disease is caused by an abnormal change (mutation) in the VHL gene. People with VHL disease have a higher chance of getting kidney cancer and other types of cancer.
c. Physical exam
Doctors usually perform a physical exam along with taking a medical history. A physical exam is a review of your body for signs of disease such as infection and areas of unusual bleeding or bruising.
During this exam, your doctor may listen to your lungs, heart, and intestines. Your doctor may also feel parts of your body to see if organs are of normal size, are soft or hard, or cause pain when touched. Your kidneys sit deep inside your abdomen and normally can’t be felt during a physical exam. But, your doctor may be able to feel a kidney that is enlarged or has a large tumor.
2. Imaging Tests
Imaging tests take pictures (images) of the inside of your body. Imaging tests are used to find and confirm (diagnose) kidney cancer. They are also used to assess the extent of the cancer to help plan treatment.
Imaging tests are often easy to undergo. Before the test, you may be asked to stop eating or drinking for several hours. You should also remove any metal objects that are on your body. Often there are no side effects.
a. Computed Tomography (CT) scan
A CT (computed tomography) scan uses x-rays to take pictures of the inside of the body. It takes many x-rays of the same body part from different angles.
All the x-ray pictures are combined to make one detailed picture of the body part. This type of scan is very good at showing kidney tumors.
A CT scan of your belly area (abdomen) and pelvis is recommended to check if there is a tumor in either of your kidneys. The pictures can clearly show the tumor size, shape, and location. This test can also show if the tumor has grown into nearby tissues.
Before the CT scan, you may be given a contrast dye to make the pictures clearer. The dye may be put in a glass of water for you to drink, or it may be injected into your vein. It may cause you to feel flushed or get hives. Rarely, serious allergic reactions occur. Tell your doctors if you have had bad reactions in the past. The contrast dye might not be used if you have a serious allergy or if your kidneys aren’t working very well.
A CT scan machine is large and has a tunnel in the middle.
During the scan, you will need to lie face up on a table that moves through the tunnel. The scanner will rotate an x-ray beam around you to take pictures from many angles. You may hear buzzing, clicking, or whirring sounds during this time.
One x-ray scan is completed in about 30 seconds. But, the full exam may take 15 to 60 minutes to complete. More or less time may be needed depending on the part of your body being scanned.
A computer will combine all the x-ray pictures into one detailed picture. You may not learn of the results for a few days since a radiologist needs to see the pictures. A radiologist is a doctor who’s an expert in reading the pictures from imaging tests.
b. Magnetic Resonance Imaging (MRI) scan
An MRI (magnetic resonance imaging) scan uses radio waves and powerful magnets to take pictures of the inside of the body. It does not use x-rays. An MRI scan is good at showing the spine and soft tissues like the kidneys and brain. It is also very useful for looking at blood vessels.
You may not be able to have a CT scan with contrast if you have an allergy to it or if your kidneys aren’t working well. In such cases, an MRI scan of your abdomen may be used instead to check for a tumor in your kidneys. For an MRI scan, a contrast dye may still be used to make the pictures clearer. MRI scans use a different kind of contrast dye than CT scans.
But, the contrast dye may not be given if your kidney function is below a certain level. In people with very poor kidney function, MRI contrast can cause a rare, but serious condition called nephrogenic systemic sclerosis.
Getting an MRI scan is similar to getting a CT scan. But, MRI scans take longer to complete. The full exam often lasts an hour or more. For the scan, you will need to lie on a table that moves through a large tunnel in the scanning machine. The scan may cause your body to feel a bit warm. Like a CT scan, you may not learn of the MRI scan results for a few days since a radiologist needs to see the pictures.
c. Ultrasound (US)
An ultrasound is a test that uses sound waves to take pictures of the inside of the body. This test can show if there is a mass in your kidneys. It can also show if the mass is solid or fluid-filled. Kidney cancer tumors are more likely to be solid.
For this test, you will need to lie down on an exam table. A gel will be spread on the area of skin near your kidneys. Next, your doctor will place the ultrasound probe on your skin and guide it back and forth in the gel. The probe sends out sound waves that bounce off organs and tissues to make echoes. The probe also picks up the echoes. A computer uses the echoes to make a picture that is shown on a screen.
Ureteroscopy uses a thin, tube-shaped tool called a scope that is inserted into your body to take pictures. Ureteroscopy is not used for kidney cancer. But, this imaging test may be used if your doctor suspects TCC or bladder cancer.
One end of the scope has a small light and camera lens to see inside your body. It allows your doctor to view your ureters and the middle part of your kidneys, called the renal pelvis. For this test, the scope will be inserted through your urethra. It will then be passed through your bladder, a ureter, and then into the renal pelvis of a kidney.
3. Blood Tests
Doctors test blood to look for signs of disease and assess your general health. These tests are not used to confirm (diagnose) kidney cancer. But, abnormal results may signal there’s a problem with your kidneys or other organs. Abnormal results may be caused by kidney cancer or other health conditions.
For a blood test, your doctor will insert a needle into a vein to remove a sample of blood. Blood is often removed from a vein in the arm. The needle may bruise your skin and you may feel dizzy afterward.
The blood sample will then be sent to a lab for testing. The blood tests used for kidney cancer are described below.
a. Complete Blood Count (CBC)
A CBC (complete blood count) measures the number of red blood cells, white blood cells, and platelets. Your doctor will want to know if you have enough red blood cells to carry oxygen throughout your body, white blood cells to fight infections, and platelets to control bleeding.
CBC test results are often abnormal in people with kidney cancer. Having a low number of red blood cells, called anemia, is common in people with kidney cancer. Your blood counts may be abnormal—too low or too high—because of kidney cancer or another health problem.
b. Blood chemistry tests
Blood chemistry tests measure the levels of the chemicals in your blood. Chemicals in your blood come from your liver, bones, and other organs and tissues. Your kidneys filter excess chemicals and waste out of your blood.
Doctors use blood chemistry tests to assess if certain organs and body systems are working well. Abnormal levels of certain chemicals can be a sign that your kidneys aren’t working well. Abnormal levels—too high or too low—may also be a sign that cancer has spread to other parts of your body.
Blood chemistry tests are given with other initial tests when kidney cancer is first found or suspected. They may also be given during and after cancer treatment to check treatment results.
A blood chemistry panel is a common test doctors give to people who have or might have kidney cancer. A blood chemistry panel measures many different chemicals in one sample of blood.
The panel will likely also include liver function tests to assess the health of your liver. Your liver does many important jobs, such as remove toxins from your blood. Liver function tests measure chemicals that are made or processed by the liver. Levels that are too high or low may be a sign of liver damage or cancer spread. One such chemical is ALP (alkaline phosphatase). High levels of ALP may mean that the cancer has spread to the bone or liver.
4. Urine Tests
Doctors test urine to look for signs of disease and assess your general health. These tests are not used to confirm (diagnose) kidney cancer. But, abnormal results may signal there’s a problem with your kidneys or other organs. Abnormal results may be caused by kidney cancer or other health conditions.
For a urine test, your doctor will ask you to fill a small container with your urine. You may only need to give one sample of urine for the test. Or, your doctor may want to collect your urine over a 24-hour period. The urine sample will be sent to a lab for testing. The urine tests that may be used for kidney cancer are described below.
Urinalysis is a test that checks the content of urine using a microscope and chemical tests. Doctors use this test to look for small amounts of blood or other abnormal substances in urine that can’t be seen with the naked eye. Blood in urine may be caused by kidney cancer or other health problems.
b. Urine cytology
Urine cytology is a test in which urine is examined with a microscope to check for cancer cells. Urine cytology is not used for kidney cancer. But, this test may be used if your doctor suspects TCC or bladder cancer.
5. Tissue Tests
A biopsy is a procedure that removes samples of tissue from your body for testing. Doctors test tumor tissue to check for cancer cells and to look at the features of the cancer cells. A biopsy is the only way to confirm (diagnose) most types of cancer.
For those cancers, a biopsy must be done before starting cancer treatment. Kidney cancer is different.
Imaging tests are very good at showing if a kidney tumor is cancer. Doctors can often confirm kidney cancer based on the imaging test results. Thus, a biopsy of the tumor is rarely needed before starting treatment. Instead, a biopsy may be done when the tumor is removed with surgery.
A biopsy may be done before treatment in some cases, such as when:
- A tumor is very small and might not be treated with surgery. In this case, a biopsy may be done to confirm kidney cancer and to help guide the treatment plan.
- Doctors think a tumor might be TCC. In this case, a biopsy may be done to confirm the cancer type.
There is more than one type of biopsy. For kidney cancer, a biopsy is done with a needle. This is called a needle biopsy. A needle biopsy uses a long, hollow needle that is inserted through your skin to remove a sample of the tumor.
Before the biopsy, the area of skin near your kidney will be cleaned. It will also be numbed with local anesthesia. Next, you may be asked to hold your breath while your doctor inserts the needle. Your doctor will push the needle through your skin and into the tumor in your kidney. Imaging tests such as a CT scan or ultrasound will help guide the needle to the right spot. A sample of tumor tissue will be collected in the hollow center of the needle.
A needle biopsy may take up to one hour to complete. You may feel some pain in your belly area afterward. Rarely, serious problems like bleeding may occur.
Tissue samples removed with a biopsy or surgery will be sent to a pathologist. A pathologist is a doctor who’s an expert in testing cells to find disease.
The pathologist will view the tissue sample with a microscope to look for cancer cells. He or she will also assess the features of the cancer cells to find out the subtype.