Diagnosing Kidney Cancer

Imaging studies and blood tests can help spot signs of kidney cancer. If you have risk factors for kidney cancer or symptoms such as blood in the urine, lower back pain, loss of appetite, fatigue or unexplained weight loss, talk to a health care provider. Diagnosing kidney cancer early may mean you have less invasive treatment options and a better outcome.

Your provider will ask for your medical history and perform a physical exam. They may also recommend:

• Ultrasound: An imaging test that uses sound waves to create images of the kidneys and nearby areas.
• Computed tomography (CT) scan: A test that uses cross-section X-ray images of the kidneys to look for tumors or abnormalities.
• Magnetic resonance imaging (MRI): A scan that uses magnetic fields and radio waves to create detailed images of the kidneys.
• Blood and urine tests: Complete blood count (CBC), blood chemistry and urine tests can check how well your kidneys are working and spot problems that could be signs of kidney cancer or other conditions.
• Biopsy: In this test, a provider removes a small sample of tissue from the kidney so it can be examined under a microscope for signs of cancer. Your provider may ask you to have a biopsy if imaging tests show a possible kidney tumor.
• Genetic testing: Your provider may recommend genetic testing if they suspect your family history might put you at risk of kidney cancer.

Types of kidney cancer

There are several different types of kidney cancer. Renal cell carcinoma (RCC) is the most common type of kidney cancer. It causes about 90% of all cases. It usually develops in one area and one kidney, but it can be in more than one area in the same kidney or in both kidneys.

There are several types of RCC. It’s important to understand the type of RCC, so you get the correct prognosis and treatment plan. 

• Clear cell RCC looks clear under a microscope. It causes about 75% of all RCC cases. It’s linked with mutations in the von Hippel-Lindau (VHL) gene, and it tends to be more aggressive than other RCC subtypes. To treat it, you may need surgery, targeted therapy, immunotherapy or a combination of treatments.
• Papillary RCC causes about 10% of RCC cases. Treatment may include surgery, targeted therapy or immunotherapy.
• Chromophobe RCC causes about 5% of RCC cases and has cells that are pale, with more noticeable cell membranes. It’s not as aggressive as clear cell RCC, but it can still spread to other parts of the body. Treatment is usually surgery. Targeted therapies don’t work as well with this type of cancer.
• Rare types of RCC include collecting duct carcinoma, renal medullary carcinoma and molecularly defined RCC (such as translocation RCC and fumarate hydratase deficient RCC) 

Other types of kidney cancer include:

• Transitional cell carcinoma: This kidney cancer, also called urothelial carcinoma, affects the lining of an area at the center of the kidney and the ureter (the tube that connects the kidney to the bladder). It’s more likely than RCC to spread to other parts of the urinary tract and is similar to bladder cancers.
• Wilms tumor: This kidney cancer, also called nephroblastoma, usually affects children between the ages of 3 and 4. It often causes a noticeable mass or lump in one kidney. It’s highly treatable, especially when it’s found early.
• Renal sarcoma: This rare type of kidney cancer starts in the kidney’s connective tissues. It can be hard to diagnose and treat. Treatment options may include surgery, chemotherapy and radiation therapy.
• Renal lymphoma: a rare type of cancer of the immune system (lymphoma) that starts in the kidney and is usually treated with chemotherapy buy may also involve radiation or surgery.   

If your provider diagnoses kidney cancer, they will evaluate its size and whether it has spread to lymph nodes or other parts of the body to determine how advanced it is:

• Stage 1: The cancer is no more than seven centimeters (about 2.76 inches) and hasn’t spread (metastasized) outside of the kidney.
• Stage 2: The cancer is bigger than seven centimeters and hasn’t spread past the area around the kidney.
• Stage 3: The cancer has spread to nearby areas and lymph nodes. It can be any size.
• Stage 4: The cancer has spread to lymph nodes further away from the kidney or other parts of the body.

Learn about treatment and support for kidney cancer.