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Diagnosis begins with a visit to the doctor. Kidney cancer may be noted when an imaging test, such as a CT scan, is ordered for an unrelated reason. Kidney cancer may have many different symptoms or no symptoms at all. Some of the symptoms include abdominal pain, blood in the urine, unexplained fever, and weight loss. However, each of these symptoms can be caused by conditions other than kidney cancer. The most common type of kidney cancer is called renal cell carcinoma, but there are several other types.
The diagnosis and prognosis of kidney cancer includes the following:
Your doctor will ask about your symptoms and medical history. You will be asked when you first noticed the symptoms and how the symptoms have progressed. Your doctor will also ask about anything that may increase your risk of kidney cancer, including:
The doctor will perform a physical exam, paying careful attention to any signs that may indicate kidney cancer, such as swelling in the legs or a lump in the abdomen.
Diagnostic tests may include:
Blood and urine tests—These tests are used to check kidney function or to find substances that indicate kidney cancer may be present.
CT scan—This is a type of x-ray that uses a computer to produce cross-sectional images of the inside of the body.
Intravenous pyelogram (IVP)—For this test, a dye is injected into one of your veins and a series of x-rays is taken. The dye courses through the urinary system, allowing x-ray pictures to be more clear and detailed.
Renal angiography—A dye is injected into an artery and a series of x-rays is taken of arteries that are leading to the kidney. The dye coats the blood vessels, making it easier to see abnormalities on the x-ray images. This test is useful in diagnosing renal cancers and can help in identifying arteries, which will help the surgeon during surgical treatment. This test is rarely used now, though.
MRI scan—This test uses magnetic waves to produce images of the inside of the body. Using a large magnet, radio waves, and a computer, an MRI produces 2D and 3D pictures.
Renal ultrasound—This involves the use of sound waves and the characteristic patterns they make bouncing off of various structures in the body to identify tumors and other conditions.
Biopsy—A biopsy is the removal of a sample of kidney tissue to test for cancer cells. This test is rarely needed, since imaging studies usually provide enough information. When a biopsy is done, the doctor inserts a needle through the skin to remove a sample of tissue from the tumor. This tissue is checked for cancer cells.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (such as surgery vs. chemotherapy).
Additional tests to determine staging may include:
Blood tests—Blood tests may help determine possible cancer spread to other parts of the body and assess your overall health.
CT scan—A series of x-rays are put together by a computer to create images of internal areas where the cancer may have spread.
MRI scan—This test is used to help assess whether the cancer has spread.
Bone scan—For this test, an injection of a radioactive compound called technetium is given. Three hours later, you lie on a table as special cameras move slowly above and below the table taking pictures. These cameras detect small amounts of radioactivity in the injected technetium, allowing the doctor to see areas of the bone that may contain cancer cells.
Renal cell carcinoma staging considers three categories: tumor, lymph nodes, and metastases (TNM).
Your doctor considers the following factors to determine the stage of renal cell carcinoma:
Kidney Cancer Tumor (T) Stages:
Kidney Cancer Node (N) Stages:
Kidney Cancer Metastatic (M) Stages:
Stage I—T1a-T1b, N0, M0
Stage II—T2, N0, M0
Stage III—T1a-T3b, N1, M0 or T3a-T3c, N0, M0
Stage IV—T4, N0-N1, M0 or Any T, N2, M0 or Any T, Any N, M1
|Overall Stage||T Stage||N Stage||M Stage|
|Stage III||T1a-T1b or T2||N1||M0|
|T3a||N0 or N1||M0|
|T3b||N0 or N1||M0|
|T3c||N0 or N1||M0|
|Any T||Any N||M1|
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available.
The five-year survival rate for all renal cell cancers is 60%. The five-year survival rate by stage is as follows:
Stage I: 90% to 100%
Stage II: 65% to 75%
Stage III: varies widely between 45% and 80%; survival goes down to 15% to 50% if the cancer has spread to other areas, like the renal vein or the regional lymph nodes
Stage IV: less than 10%
There are certain risk factors that affect the five-year survival rate. These factors can shorten a patient’s survival time:
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Kidney Cancer Association website. Available at: http://www.kidneycancerassociation.org.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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