Renal Cell Carcinoma

Diagnosing

Doctors may use several tests that examine the abdomen and kidneys to diagnose your specific type of renal cell carcinoma (RCC). Following your diagnosis, your doctor also uses these test results to determine the extent of the disease, a process called staging. Accurately diagnosing and staging your RCC helps your doctor recommend the best treatment options for you, which may spare you from treatment that is unlikely to be effective.

Physical Exam and Laboratory Tests

Your doctor and health care team will obtain your complete medical history and perform a thorough physical examination. During the physical exam, the doctor will press on your abdomen to see if he or she can feel a mass or enlargement of nearby lymph nodes, where a cancer may spread. Laboratory tests, including blood and urine tests, may also be done. These results will provide your doctor with a baseline measurement of your overall health, kidney function and cancer status.

Your doctor may order a urinalysis and/or a urine cytology test. A urinalysis is a test done on a sample of your urine to see if blood or other indicators of an abnormality, such as sugar, proteins or bacteria, are present. For a urine cytology test, the urine sample is viewed through a microscope and examined for cancer cells.

Blood Tests

Further laboratory evaluation will include blood tests. A complete blood count (CBC) is a measure of the number of red and white blood cells and platelets in the blood. CBC results may be abnormal in people with kidney cancer. A comprehensive metabolic panel, which is a group of blood tests, is usually done and can provide doctors with an overall picture of the body’s chemical balance, including information about how your kidneys and liver are working. Abnormal results can indicate a variety of medical conditions, including problems with the kidneys.

Imaging Studies

Imaging studies are used primarily to help define the size, shape, location and spread of the tumor. They are also useful for assessing other parts of the body to see if the cancer has metastasized (spread) beyond the kidney, which helps define the stage of the disease. You may not need to have every diagnostic imaging study. Your doctors will consider the results of your physical examination and your general health status in deciding which tests will provide the most useful information.

Computed Tomography (CT)

CT produces three-dimensional, cross-sectional X-ray images, so it can provide more precise details than a standard X-ray. For this test, a special dye (called a “contrast”) may be injected into your vein, and you will likely be asked to swallow another type of dye. These dyes help better define organs and tissues on the images. CT is excellent for assessing the size of the lymph nodes, as well as the presence of abnormalities in the liver, bones or lungs; however, the size of lymph nodes does not always indicate whether or not the nodes contain cancer. Thus, other studies to evaluate the lymph nodes may be done. In cases of RCC, CT scans of the abdomen, pelvis and chest, and sometimes the brain, are often necessary.

Magnetic resonance imaging (MRI)

MRI involves the use of strong magnets and magnetic waves to produce images. An MRI of the abdomen will provide images of the urinary tract, liver, bones, intestines and lymph nodes. These can show cancer in the kidneys, lymph nodes or other nearby tissues. An MRI is often done instead of CT for people who cannot tolerate the contrast dye used with CT because of an allergy or poor kidney function.

Positron Emission Tomography (PET)

PET images are not as finely detailed as those from CT, but they can help doctors decide whether a mass contains cancer and sometimes disclose whether there are deposits of abnormal cells not seen on CT or MRI scans. Currently, however, PET is not a standard tool used during the diagnosis of RCC.

Ultrasound

Ultrasound involves the use of sound waves to produce images of the organs inside the abdomen, including the kidneys and nearby tissues. The images can also show a tumor in the kidney.

Intravenous Pyelogram (IVP)

For this test, a dye is injected into a vein in your arm, and X-rays are taken as the dye travels through the bloodstream into the kidneys, ureters and bladder. The dye will highlight any tumor that is present.

Bone Scan

A bone scan is done to see if RCC has spread to bone. A small amount of a radioactive material that is preferentially deposited in damaged bone is injected through a vein in the arm, and a special camera is used to see if the radioactive material has deposited in bone. This radioactive material will not make your body radioactive, and the dose of radiation in the material is less than what you’re exposed to during regular X-rays.

Renal Arteriography

Also called renal angiography, renal arteriography is a test to examine the blood vessels that feed the kidney and a tumor. A contrast dye is injected through a vein in your arm, and a catheter is then inserted into the renal artery, a large artery near the groin that leads to the kidney. A dye is also injected directly into the arteries into the kidneys. The dye defines the blood vessels in the normal kidney and any tumor present so it can be seen more clearly on X-rays. Renal arteriography can help your doctor plan surgery to remove a tumor.

Biopsy Procedures

Because doctors can usually diagnose RCC with imaging tests, a biopsy is often not needed. However, a biopsy may be done if imaging tests have not shown for sure whether cancer is present. Two types of biopsy may be done to help diagnose RCC: fine needle and core needle. During a fine-needle procedure, the doctor inserts a thin needle into the suspected tumor, using CT or ultrasound to help guide the needle. Fluid or small pieces of tissue can be removed through the needle. In a core-needle biopsy, the needle is larger and a small cylinder of tissue can be removed. For both types of procedure, the area where the needle will be inserted is first numbed with a local anesthetic so that you won’t feel much pain.

Samples of tissue obtained during a biopsy are examined by a pathologist (a doctor who specializes in the analysis of body tissues and the diagnosis of diseases), who will look to see if cancer cells are present and, if they are, to determine the specific type of cancer cells. In some instances, the pathologist may not be able to identify the type because the tissue sample is too small. When this happens, another biopsy may be necessary. If imaging tests show a solid and growing mass, surgeons may remove the tumor first. In completing a pathology report following the operation to remove the cancer, the pathologist will note the size and location of the tumor, whether lymph nodes contain cancer cells, and other important facts about the cancer. The pathologic evaluation of biopsy samples offers the most valuable information for the diagnosing and staging of RCC.