Renal Cell Carcinoma
Several tests are available to help your doctors learn more about your renal cell carcinoma (RCC). These tests provide details that help your doctors make a specific diagnosis about the type of RCC you have. They also offer information that helps with assigning a stage to the cancer. An accurate diagnosis and stage are essential for determining the best treatment options, which may spare you from treatment that is unlikely to be effective.
Physical exam and laboratory tests
If you show signs or symptoms of RCC, your doctor will obtain your complete medical history and perform a thorough physical examination. During the physical exam, the doctor may examine the abdomen to reveal the possible presence of a mass or an organ enlargement. Laboratory tests, including blood and urine tests, may also be done to provide your doctor with a sense of your overall health, kidney function and cancer status.
If RCC is suspected, your doctor may order a urinalysis and/or a urine cytology. A urinalysis tests your urine for blood and other indicators of cancer, such as sugar, proteins and bacteria. In a urine cytology, the urine is viewed through a microscope and examined for cancer cells.
Further laboratory evaluation may include blood tests. A complete blood count (CBC) measures the red and white blood cells and the platelets in the blood. The results are often abnormal in people with kidney cancer. A comprehensive metabolic panel, which is a group of blood tests, is also common. It can provide doctors with an overall picture of the body’s chemical balance and metabolism, including information about how your kidneys and liver are working as well as your blood sugar, cholesterol, calcium, electrolyte and protein levels. Abnormal results can indicate a variety of medical conditions, including problems with the kidneys.
Diagnostic imaging studies
Imaging studies are primarily used to help define the size, shape and location of the tumor. They are also useful in assessing other parts of the body to see if the cancer has metastasized (spread) beyond the kidney, which aids in defining 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.
Computerized tomography (CT)
CT produces three-dimensional, cross-sectional X-ray images, so it can provide more precise details than a standard X-ray. CT scans provide an excellent assessment of the size of the lymph nodes, but the size does not always indicate whether or not the nodes are involved with cancer. Thus, other studies to evaluate the lymph nodes may be done. In cases of RCC, CT scans of the abdomen, pelvis and chest are usually necessary.
Abdominal magnetic resonance imaging (MRI)
Abdominal MRI scans use strong magnets and radio waves to produce images of the urinary tract and lymph nodes. They can show cancer that is in the kidneys, lymph nodes or other tissues in the abdomen. MRI scans are often used in place of CT scans when the patient cannot receive the contrast dye necessary for CT scans due to an allergy or poor kidney function.
Positron emission tomography (PET)
PET scan images are not as finely detailed as those from a CT scan, but they can be useful if your doctor thinks the cancer may have spread beyond the kidney but does not know where. Currently, however, PET scans are not a standard tool used during RCC diagnosis.
Ultrasound uses 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. And if a kidney biopsy is necessary, ultrasound can help guide the needle into the mass to take a sample.
In cytoscopy, a hollow tube equipped with a lens (cytoscope) is inserted into the urethra and slowly advanced into the bladder. Cytoscopy is sometimes used to confirm that there are no tumors in the bladder as well as determine whether there is bleeding from one or both kidneys.
Intravenous pyelogram (IVP)
IVP is not as common as CT or MRI in RCC detection and diagnosis, but it is sometimes used. For this procedure, a dye is injected into a vein in your arm. The dye travels with the blood into the kidneys and then into the ureters and the bladder. X-rays are taken at that point, which can find a tumor and show any damage it may have caused.
Radionuclide imaging uses a gamma camera to create an image following the injection of a radioactive material. Radionuclide imaging exposes the patient to less radiation than comparable X-rays and is most often used to detect possible RCC metastasis to the bone.
Also called a renal angiogram, renal arteriography is an X-ray test using a contrast dye. After the dye is injected, a catheter is threaded up a large artery near the groin that leads to the kidney (the renal artery). It helps outline the blood vessels that are feeding the tumor and assists doctors in planning for tumor removal surgery.
Because doctors can generally diagnose RCC through imaging tests, biopsies often are not needed. However, they may still be done if other tests have not shown for sure whether cancer is present. A biopsy removes tissue to look for cancer cells through one of two types: fine needle and core needle. During a fine needle procedure, a fine, thin needle is inserted and guided by CT or ultrasound into the suspected tumor. Fluid or small pieces of tissue are then removed. In core biopsy procedures, the needle is larger and a small cylinder of tissue is removed. For both types, the needle insertion site is first numbed with a local anesthetic.
Samples of tissue obtained during these procedures are examined by a pathologist to see if cancer cells are present and, if so, to determine what kind of cancer the cells represent (the histologic type). The pathologist will also document the size and location of the tumor, the number of lymph nodes that contain cancer cells and other important facts about the cancer. In some instances, the pathologist may not be able to identify the histologic type because the tissue sample is too small. When this happens, another biopsy may be necessary. The pathologic evaluation of biopsy samples offers the most valuable information for the diagnosing and staging of RCC.
Questions to ask your doctor about your prognosis
If you would like to know more about your possible prognosis (chance for recovery from treatment), do not be afraid to ask your doctor. Learning about your prognosis can help you better plan for the future.
What is my prognosis?
What are my chances of being cured?
What are the chances that my cancer will come back?
What can I do to improve my prognosis?