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How is renal cancer diagnosed?

The diagnosis of kidney cancer usually happens accidentally, when the patient undergoes ultrasound of the abdomen for any kind of pain. But sometimes, depending on individual’s symptoms, the doctor may decide to perform a physical exam.

If results of the physical exam indicate signs of kidney cancer, more lab tests are prescribed to confirm the presence of a tumor, this include imaging tests, or a biopsy of the kidney.

And, because the first step to treat renal cancer is to correctly diagnose the cancer, at AOI – the best hospital for diagnosis of kidney cancer, we recommend the following preliminary and diagnostic tests to our patients:

Urinalysis
Blood Chemistry Studies
Imaging Tests – X-rays, MRI, Ultrasound, CT Scan, Renal Arteriogram
Biopsy

Once the specialist has the outcomes of these diagnostics tests, he/she will be able to work on a treatment plan.

In case there’s any uncertainly or if the doctor wants to investigate the case further, they may prescribe some more tests. This is done to determine if cancer has spread to other organs and also to find out the stage and grade of cancer, at that moment.

Blood and urine tests

When is blood and urine test done?

If the patient experiences some signs and symptoms of kidney and urinary tract issues then the doctor may order them a urine and blood test.

During a urine test, a urine sample is evaluated for the presence of blood and other substances which are generally not seen with the naked eye. Similarly, a doctor may recommend a blood test to learn the number of red blood cells in the blood.

On the basis of these test reports, the doctor may further advise other investigative and confirmatory tests.

How do I prepare for a blood and urine test?

Tests for kidney function normally need a 24-hour urine sample. Whereas, blood sample is taken from the arm vein. It is tested for various parameters. However, there is no special preparation needed for either of these tests.

How is this test performed?

A 24-hour urine sample is collected at regular intervals and tested for protein content, creatinine release and GFR (Glomerular Filtration Rate).

What to expect after blood and urine test?

Creatinine level more than 1.4 mg/dL for men and 1.2 mg/dL for women reflects some issues in kidney.
Blood Urea Nitrogen (BUN) level between 7 and 20 mg/dL is normal. Any variations from this may indicate poor kidney health.
GFR level below 60 ml/min/1.73m2 can be due to kidney problem.

How do you receive the results of blood and urine test?

You may receive the results of your blood and urine test in a day’s time. Generally, the lab technician handovers the detailed report to the patient and the doctor.

Blood and urine test result accuracy

Blood and urine test cannot confirm cancer but these tests may sometimes give an indication that there’s a kidney problem. Thus, based on results, other confirmatory tests may be ordered, if the need arises.

Biopsy

When is the biopsy done?

On account of symptoms related to kidney problems and subsequent blood and urine tests at preliminary stage analysis, your doctor may prescribe the biopsy as a confirmatory test for cancer.

A kidney or renal biopsy is generally recommended for the following reasons:

Decreased kidney function
Diagnose suspected kidney problem
Blood in urine
Determine how quickly renal cancer is progressing
Excess protein content in urine due to kidney problem
Develop effective cancer treatment plan

How do I prepare for a biopsy test?

For surgical or needle biopsy, the doctor may ask the patient to discontinue any medications, such as, omega-3 fatty acids, Ibuprofen, NSAIDs, Aspirin and blood thinners, etc., prior to the test.

Also, the patient may be advised not to drink or eat eight hours prior to the procedure.

How is this test performed?

During a kidney biopsy, your doctor will use a needle to remove a small sample of kidney tissue for lab testing. The biopsy needle that’s inserted through your skin is often directed with the guidance of imaging devices, such as ultrasound.

What to expect after biopsy?

After the biopsy, you can expect to:

Get your blood pressure, pulse and breathing monitored
Get complete blood count tests and urinalysis to check for bleeding and other complications
Rest for around four to six hours
Feel some pain at the biopsy site

Are there any risks associated with the renal biopsy?

Generally, the renal biopsy is considered to be a safe procedure. However, some possible risks associated with the procedure include:

Blood in urine: Bleeding generally stops within a few days, but if the bleeding persists for more than 2-3 days, contact your doctor.
Pain: Pain at the biopsy site usually lasts only a few hours.
Arteriovenous Fistula: The condition develops if the biopsy needle accidentally damages the walls of the artery or vein. This type of fistula causes no symptoms and closes on its own.
Other Infections: Rarely, a collection of blood around the kidney becomes infected. This can be treated with antibiotics.

How do you receive the results of the biopsy?

After the biopsy test, your kidney tissue goes to a lab to be examined by a pathologist. It can take up to 7 days before your biopsy report is prepared, however, in case of emergency, a partial report can be released in less than 24 hours. After getting the report, your doctor may explain the outcome of the test and possible course of treatment to you.

Biopsy result accuracy

In general, needle biopsies have a higher risk of a false negative result than a surgical biopsy. This generally happens because needle biopsies tend to take a smaller tissue sample that may not be sufficient to detect the cancer.

Computed Tomography (CT)

When is computed tomography (CT) done?

Computed tomography imaging is done to reveal accurate information about the location, size, and shape of the tumor.

It is also performed to assess the kidneys for lesions and obstructions, etc., particularly when another type of examination, such as X-rays or physical examination is not conclusive.

CT scan of the kidney also helps in performing kidney biopsies. Besides, it helps in evaluating the spread of cancer from the kidney to other tissues or organs.

How do I prepare for a computed tomography (CT)?

If you have a CT or virtual colonoscopy, you will be asked to follow a specific set of instructions. This may include: removing all jewelry and valuables, not eating anything three hours prior to the scan, but that’s only if your doctor has ordered a scan with contrast. But as a precautionary measure, make sure to inform your doctor if you are a diabetic, pregnant or a nursing mother.

How is this test performed?

CT scans are either performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition.

However, if you are to have a procedure done with contrast, an intravenous (IV) line will be started in the hand or arm for injection of the contrast media. For oral contrast, you will be given a liquid contrast to swallow.

The contrast dye is often needed to make certain areas stand out better on the scan, but in some cases it can be done without contrast dye as well.

What to expect after computed tomography (CT)?

In case contrast media was used during your CT; you may be monitored for a short period. This is to look out for side effects such as itching, swelling, rash, or difficulty breathing.

So, if you experience pain, redness, and/or swelling at the IV site following your procedure, make sure to inform your doctor as this could indicate an infection.

Otherwise, there is no special type of care required after a CT scan of the kidney and you may resume your usual diet and activities.

How do you receive the results of computed tomography (CT)?

The CT scan reports are analyzed by the technician and consulting doctor, based on which a treatment regime is prepared for the patient. The doctor may explain the results to the patient before changing or beginning the cancer treatment.

Computed tomography (CT) result accuracy

A CT scan provides precise information about the size, shape, and location of a tumor. It is also useful in checking if cancer has spread to nearby lymph nodes or to organs and tissues outside the kidney.

In general, CT tests can diagnose kidney cancer with more than 98% accuracy, specificity and sensitivity.

X-ray

When is X-ray done?

X-ray for kidney cancer diagnosis is generally prescribed if your doctor suspects that your renal cancer has spread to the lungs. Even though doctors prefer to have a CT chest for better visuals and analysis, sometimes they use chest X-rays to plan a cancer treatment such as chemotherapy or radiation therapy, etc.

How do I prepare for X-ray?

X-rays generally do not require any special preparation, however, your radiologist may ask you to remove any metal jewelry or accessory, like eyeglasses before performing the imaging test. Also, as a precautionary measure it’s advisable to tell your doctor and the technologist if you are pregnant or a nursing mother.

How is this test performed?

X-ray is a safe and painless test that uses a small amount of radiation to produce pictures of a person’s chest. After an X-ray machine sends a beam of radiation through the chest, an image is recorded on a special film or a computer.

This image includes organs and structures such as the heart, lungs, large blood vessels, lymph nodes, the upper spine, ribs, collarbone, and breastbone, etc.

What to expect after X-ray?

The patient can resume normal routine activities after the test with no side effects in general. The patient may be advised to drink plenty of water to flush out the contrast dye, if administered before the test. Some patients may experience redness, swelling or pain at the site of injection which can be easily managed with medication.

How do you receive the results of X-ray?

The results of a chest X-ray is available almost immediately for your radiologist or physician to review it.

X-ray result accuracy

The diagnostic accuracy of a chest X-ray in case of renal cancer is around 95%.

Magnetic Resonance Imaging (MRI)

When is magnetic resonance imaging (MRI) done?

If an individual has issues related to kidney function or allergy to the contrast dye, then the doctor may recommend an MRI scan. Also, if the doctor suspects that cancer has spread into the abdominal area or to blood vessels, even then he/she may order an MRI scan. MRI scan shows soft tissues in great detail. It clearly shows blood vessels and lymph nodes to look for any abnormality.

How do I prepare for a magnetic resonance imaging (MRI)?

If you have undergone any operation or got any implants, inform your doctor in advance. For this test, you do have to lie still on a hard table inside a narrow tube. As some people don’t feel comfortable in close or confined spaces, so, if you have a history of anxiety or fear of closed spaces, tell your doctor in advance. You may be asked to take a drug to relax before the test. Other than that, no other preparation is needed.

How is this test performed?

Magnetic Resonance Imaging (MRI) involves the application of the magnetic field to generate detailed images of the targeted part of the body. A radiotracer is administered to the patient that helps in creating contrast images for detection of cancer.

What to expect after magnetic resonance imaging (MRI)?

The MRI test takes about 30 to 60 minutes. After the test, you can get back to your normal daily activities. Some patients may experience a temporary allergic reactions due to the administration of radiotracer, but these symptoms are temporary and can be easily managed with medication.

How do you receive the results of magnetic resonance imaging (MRI)?

After the complete analysis, a detailed MRI report is prepared by the radiographer in about 3-5 days time.

Magnetic resonance imaging (MRI) result accuracy

The diagnostic accuracy of MRI scan for detection of kidney cancer is more than 85%. An MRI scan provides improved result as compared to a CT scan and ultrasound, but it still lacks the accuracy and detail received by PET/CT scan.

Cystoscopy and Nephro-ureteroscopy

When is cystoscopy and nephro-ureteroscopy done?

Often, cystoscopy and nephro-ureteroscopy tests are done to detect urothelial cancer of the renal pelvis or the upper urinary tract. These tests are not used for the diagnosis of renal cell carcinoma unless imaging test detects a mass or stone in the bladder.

How do I prepare for a cystoscopy and nephro-ureteroscopy?

Based on the patient profile, the doctor may suggest special preparation for these tests. Normally, patients are asked to undergo the test empty stomach and provide urine sample to check for any infection. In such cases, patients also need to hold urine for about one hour.

How is this test performed?

During these procedures, the patient is sedated, while a urologist may insert a tiny lighted tube into the bladder through the ureter and up into the kidney. The procedure aids in performing a biopsy, and sometimes to completely destroy small tumors. In ureteroscopy, the doctor may insert the ureteroscope via bladder into a ureter to examine the ureter lining.

What to expect after cystoscopy and nephro-ureteroscopy?

After these procedures, a patient may experience numbness from the local anesthesia that was used during the procedure. But this lasts for a short duration and generally goes away within 1 to 3 hours.

The patient may also feel burning or slight pain while urinating for the next 2 to 3 days or may see a small amount of blood in their urine, but that’s normal.

How do you receive the results of cystoscopy and nephro-ureteroscopy?

It may take one or two weeks to prepare results of cystoscopy and nephro-ureteroscopy. A specialist may study the test results and explain it to the patient as well as help in deciding the further course of treatment.

Cystoscopy and nephro-ureteroscopy result accuracy

After performing these tests, your doctor will review the results and will look for the presence of any cancerous tumor. Also, the report helps the doctor to describe the cancer. This is called staging.

Ultrasound

When is Ultrasound done?

Ultrasound is usually recommended if your doctor is trying to figure out whether the mass detected in your kidneys is a fluid-filled cyst or a solid tumor.

This non-invasive test helps to evaluate the location, size, and shape of your kidneys as well as their basic functioning. A kidney ultrasound usually includes your bladder, too. It can also explain if the tumor diagnosed is malignant or benign.

Besides, ultrasound is also used to guide kidney biopsy needles for the collection of the sample from the kidney tumor mass.

How do I prepare for Ultrasound?

Usually, you don’t have to do anything special to prepare for a renal ultrasound, although the doctor may ask you to drink enough water at least one hour before the exam and hold urine until the test is done. Also, you will be asked to remove the jewelry and metallic objects before proceeding with the test.

How is this test performed?

In an ultrasound, sound waves are used to produce pictures of your internal organs. These show if there is a tumor present in your kidney.

As the scanning begins, a gel is evenly spread over your abdomen or back, followed by which a transducer is passed over the area. The transducer is a small device that sends out sound waves that echo when they encounter something dense, like an organ or a tumor. An ultrasound is painless and takes about 15 minutes.

How do you receive the results of Ultrasound?

A radiologist may interpret ultrasound results to explain it to the patient and the doctor to decide on the further course of treatment. In case of emergency, results can also be prepared in one or two hours, however, normally it takes half a day.

Ultrasound result accuracy

The accuracy of renal ultrasound is expected to be 85% in diagnosing benign cysts and 100% in detecting malignant cysts, extra renal lesions, polycystic disease and solid mass.

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