Kidney cancer - Diagnosing kidney cancer

In many cases, kidney cancer is diagnosed after routine scans and check-ups, as the condition doesn't always have obvious symptoms.

Seeing your GP

You should see a GP if you have any symptoms of kidney cancer, such as blood in your urine or a constant pain below your ribs.

Your GP will examine you and, if they think your symptoms need further assessment, refer you to a specialist urologist (a doctor who specialises in conditions that affect the urinary tract).

If you notice blood in your urine, your GP will usually carry out a blood test and take a urine sample. The results will help rule out other possible causes, such as infection or kidney stones.

The National Institute for Health and Care Excellence (NICE) has issued guidance for GPs about making referrals in cases of suspected cancer to specialist services. If you need to be referred urgently, you'll usually be seen within two weeks.

Further tests

If your GP refers you to a hospital specialist, further tests will help determine whether you have kidney cancer.

Ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of an organ in the body. It can often detect changes in the shape of the kidney that might be caused by a cancerous tumour.

An ultrasound scan may be needed if the cause of the blood in your urine can't be found.

Computerised tomography scan

You may also be referred for a computerised tomography (CT) scan. During a CT scan, a series of detailed images of the inside of your body are taken and put together by a computer.

If you have a CT scan, you may be given a special dye to drink, or it may be injected. The dye makes the results of the CT scan clearer.

Image-guided biopsy

In some cases of kidney cancer, an image-guided biopsy is carried out. It's a minor surgical procedure performed under local anaesthetic. This means you'll be awake during the procedure, but the area surrounding the affected kidney will be numbed, so that you don't feel anything.

During an image-guided biopsy, a radiologist or surgeon will use an ultrasound or CT scan to guide a needle through your skin and into your kidney. A small tissue sample will be removed from your kidney and examined under a microscope to check for cancerous cells.

Magnetic resonance imaging (MRI) scan

You may also need to have a magnetic resonance imaging (MRI) scan, which can be used to produce detailed images of your kidneys. The images can help identify a tumour and determine its size.

Cystoscopy

A cystoscopy is medical procedure that uses an instrument called a cystoscope to examine the inside of your bladder and urinary system.

This procedure doesn't look at the kidneys, but it can rule out or confirm whether any bleeding is coming from problems in the bladder.

Intravenous pyelogram (IVP)

An intravenous pyelogram (IVP) test involves injecting a dye into your bloodstream. X-rays are taken after a short time, with the dye highlighting any growths present in the kidneys.

Staging and grading

If kidney cancer is confirmed, it's usually possible to determine its grade and stage.

The stage describes how far the cancer has spread, and the grade describes how aggressive the cancer is and how quickly it's likely to spread.

Both the stage and grade of your kidney cancer will help determine your recommended treatment and the likelihood of achieving a cure.

Healthcare professionals use the TNM system to stage kidney cancer:

• T – indicates how large the tumour has grown (a tumour is a lump of cancerous tissue)
• N – indicates whether nearby lymph nodes are affected (lymph nodes are small, oval-shaped glands found throughout the body, which help protect against infection)
• M – indicates whether the cancer has spread to another part of the body (M stands for metastases, which is the medical term for cancer that has spread)

The stages of tumour size are:

• T1a – where the tumour is less than 4cm (about 1.6 inches) in diameter
• T1b – where the tumour is 4-7cm (about 1.6-2.8 inches) in diameter
• T2 – where the tumour is larger than 7cm (2.8 inches) in diameter, but hasn't spread out of the kidney
• T3a – where the tumour has spread into the adrenal gland or the layer of fat surrounding the kidney
• T3b – where the tumour has spread into the renal vein (the vein that carries blood back from the kidney to the heart) or into the vena cava (the vein that carries blood back from the top half of the body)
• T3c – where the tumour has spread past the diaphragm (the sheet of muscle that separates the top part of the abdomen from the bottom part)
• T4 – where the tumour has spread beyond the tough layer of tissue that surrounds and protects the kidney

There are three lymph node stages:

• N0 – where no lymph nodes have been affected
• N1 – where there are cancer cells in one lymph node
• N2 – where there are cancer cells in two or more lymph nodes

M0 means that the cancer hasn't spread to another part of the body. M1 means that the cancer has spread.

Kidney cancer is graded using a scale of one to four. The higher the grade, the more aggressive the cancer.

Coping with cancer

Being diagnosed with cancer can be very distressing, particularly if it's incurable. The news can often be difficult to take in and comprehend.

After cancer has been diagnosed, you may find that talking to a counsellor or psychiatrist helps you deal with feelings of depression and anxiety. Antidepressants may also be used to help you through this process.

Read more about coping with a cancer diagnosis. More information can be found on our pages about living with cancer and what sort of support is available for people with cancer?