How Kidney Cancer is Diagnosed

What to expect during your GP surgery consultation

Your doctor (GP) will probably carry out some initial tests. The GP will ask about your general health, examine you and ask for a urine sample. This will be analysed to see if it contains blood. You may also be asked for a blood sample. This will be tested to see how well your kidneys are working. The GP may also perform a physical examination to check for any lumps or swelling; however, small tumours are difficult to detect on a physical examination because the kidneys are deep inside the body.

Your GP may then refer you to a hospital specialist for further tests, especially if you have blood in your urine. There are special referral guidelines for GPs to help them decide who needs to be referred to a specialist urgently.

What to expect during a hospital referral

The hospital specialist, usually an urologist, will want to know about your medical history and symptoms. If anyone else in the family has had kidney cancer you should mention this. You will have more blood and urine tests, such as a full blood count (FBC) and urea and electrolytes (U&Es), to test the function of your kidneys. If you want to know the results of your blood tests, please ask your doctor to explain them.
Ultrasound scan

Your doctor will also want to look at your kidneys. Usually the first test he or she will do is an ultrasound scan, which is a real-time, moving test used to detect and differentiate between tumours and cysts on the kidney. This is a painless procedure that is done in the hospital scanning department and only takes around 10 – 20 minutes to perform. During the kidney ultrasound, you will be asked to lie on a padded examining table. A water-soluble gel is spread over your abdomen and kidney area. A small probe is then gently applied against your skin and rubbed over the area. The sound wave echoes are detected by the probe and turned into a picture of the organs and structures inside your body, by a computer.

Ultrasound scan

Your doctor will also want to look at your kidneys. Usually the first test he or she will do is an ultrasound scan, which is a real-time, moving test used to detect and differentiate between tumours and cysts on the kidney. This is a painless procedure that is done in the hospital scanning department and only takes around 10 – 20 minutes to perform. During the kidney ultrasound, you will be asked to lie on a padded examining table. A water-soluble gel is spread over your abdomen and kidney area. A small probe is then gently applied against your skin and rubbed over the area. The sound wave echoes are detected by the probe and turned into a picture of the organs and structures inside your body, by a computer.

Cystoscopy

If you have blood in your urine, your doctor might want to carry out a cystoscopy to check inside your bladder. The procedure is carried out under local anaesthetic or sometimes under general anaesthetic. A fine, flexible tube with a light in the end (called a cystoscope) is passed up your urethra and into your bladder, where it acts like a telescope allowing the doctor to see inside your bladder.

If the initial investigations confirm you have kidney cancer, you will need more tests to help doctors see if it has spread and how best to treat it. However, some of the following tests may also be used when your doctor is still trying to determine whether you have kidney cancer or not:

CT scan

Computerised tomography (CT) is a special type of X-ray examination and is conducted in the X-ray department of the hospital. A CT scan is used to check the size of the tumour and whether it has spread to other organs, such as the lungs and the other kidney.

The CT scanning machine takes a series of X-ray pictures of your body from different angles. A computer puts these images together to give a detailed image of the inside of your body. You will need a full bladder for this examination, so you will not be able to go to the toilet beforehand. The machine is shaped rather like a ring doughnut. You lie on a couch, which slides backwards and forwards through the hole. The radiographer cannot stay in the room with you during the scanning, but will be able to see you on a TV screen and talk to you through an intercom. You may be given an injection of a special dye, or contrast agent, into a vein in your arm to help blood vessels show up more clearly. A CT scan is painless but takes longer than an X-ray. The length of the whole procedure depends on how many pictures are taken, but expect to be on the couch for about 30 minutes. Some people feel a little claustrophobic during a scan. If you think you might, tell the radiographers before the day of your appointment.

Biopsy

Doctors can usually make a confident diagnosis from a CT scan alone. Occasionally a biopsy will also be carried out. A thin needle is put through the skin and muscle into the kidney to remove a small sample of tissue. This is then examined under a microscope to check for signs of cancer. You will need to be observed for about four to six hours after the biopsy, and may require an overnight hospital stay.

MRI scan

Magnetic resonance imaging (MRI) is a type of scan that uses magnetism instead of X-rays to construct a detailed picture of the inside of your body. MRI is used to check the size and extent of a tumour, and to determine whether or not the cancer has spread to other organs of the body. You may be given an injection of special dye or contrast agent into a vein to help the tumours show up more clearly on the MRI scan picture.
Similar to the CT machine, the MRI machine is shaped like a long tube and you lie on a couch, which slides backwards and forwards through the hole. The radiographer watches you on a monitor and can talk to you through an intercom. During the test you have to lie very still on the couch inside the tube for about 30 minutes. It is painless but very noisy and can make people feel a little claustrophobic. If you think you might feel claustrophobic during your scan, please tell the radiographer before your appointment. You should be given earplugs or headphones through which you can listen to music and will be able to hear the radiographer.

Bone scan

You might be asked to have a bone scan to see whether the cancer has spread to your bones. If so, you will be injected with a mildly radioactive material and then asked to wait for a couple of hours while it travels through the blood and collects in the bones. Areas where there is damage to the bone will show up as ‘hot spots’. These aren’t necessarily the result of cancer. If you have arthritis, for instance, this will show up on the scan.

Chest X-ray

A chest X-ray may be carried out to check your general health and make sure that you are fit enough to have certain treatments or surgery. It will also be used to rule out cancer that has spread to the lungs.

You will be asked to go back to the hospital for the results of your tests. This may take a little while and you will probably feel worried and upset during this time.

Is there anyone you can share your feelings with? Is there a clinical nurse specialist you can talk to? It might be helpful to contact a support group and talk to someone who has been in your shoes. There are some useful numbers listed at www.kcuk.org.uk.

What are my chances of survival?

Being told you have kidney cancer is always a shock. People react in different ways. Some want to find out as much as they can about their treatment and their long-term prospects. Others don’t want to think about the future, preferring to take each day as it comes, without worrying about what may or may not lie ahead.

As doctors know only too well, it can be very difficult to predict what will happen because every patient is an individual. Of course, the earlier your cancer is detected and the sooner treatment begins, the better your chances of long-term survival. Even if your cancer has spread, making it more difficult to treat, it is possible for the symptoms to be kept under control for years. And in some rare cases patients may go into remission for no apparent reason.

There are statistics about average survival rates for people diagnosed with different stages of kidney cancer. You can look at these on this page of our website if you choose to. If you do, bear in mind that these are averages and will not tell you how well you will do. Some patients, originally warned that their prospects of survival were poor, have lived for much longer and had a much better quality of life than expected.