To find the cause of symptoms, the doctor asks about the patient's medical history and does a physical exam. In addition to checking for general signs of health, the doctor may perform blood and urine tests. The doctor may also carefully feel the abdomen for lumps or irregular masses.
The doctor usually orders tests that produce pictures of the kidneys and nearby organs. These pictures can often show changes in the kidney and surrounding tissue. For example, an IVP (intravenous pyelogram) is a series of x-rays of the kidneys, ureters, and bladder after the injection of a dye. The dye may be placed in the body through a needle or a narrow tube called a catheter. The pictures produced can show changes in the shape of these organs and nearby lymph nodes.
Another test, arteriography, is a series of x-rays of the blood vessels. Dye is injected into a large blood vessel through a catheter. X-rays show the dye as it moves through the network of smaller blood vessels in and around the kidney.
Other imaging tests may include CT scan, MRI, and ultrasonography, which can show the difference between diseased and healthy tissues.
If test results suggest that kidney cancer may be present, a biopsy may be performed; it is the only sure way to diagnose cancer. During a biopsy for kidney cancer, a thin needle is inserted into the tumor and a sample of tissue is withdrawn. A pathologist then examines the tissue under a microscope to check for cancer cells.
Once kidney cancer is diagnosed, the doctor will want to learn the stage, or extent, of the disease. Staging is a careful attempt to find out whether the cancer has spread and, if so, what parts of the body are affected. This information is needed to plan a patient's treatment.
To stage kidney cancer, the doctor may use additional MRI and x-ray studies of the tissues and blood vessels in and around the kidney. The doctor can check for swollen lymph nodes in the chest and abdomen through CT scans. Chest x-rays can often show whether cancer has spread to the lungs. Bone scans reveal changes that may be a sign that the cancer has spread to the bones.
Once renal cell cancer has been found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for renal cell cancer:
Stage I Kidney Cancer
In stage I kidney cancer, the cancer is found only in the kidney.
Stage II Kidney Cancer
When a stage II kidney cancer diagnosis is made, the cancer has spread to the fat around the kidney, but the cancer has not spread beyond this to the capsule that contains the kidney.
Stage III Kidney Cancer
Stage III kidney cancer is classified by the cancer spreading to the main blood vessel that carries clean blood from the kidney (renal vein), to the blood vessel that carries blood from the lower part of the body to the heart (inferior vena cava), or to lymph nodes around the kidney. (Lymph nodes are small, bean-shaped structures that are found throughout the body; they produce and store infection-fighting cells.)
Stage IV Kidney Cancer
With stage IV kidney cancer, the cancer has spread to nearby organs such as the bowel or pancreas or has spread to other places in the body such as the lungs.