Kidney Cancer – Diagnosis and Treatment
Diagnosis
Checking Blood and Urine
Doctors often begin by checking blood and urine when they look for kidney cancer. Blood tests, such as a complete blood count (CBC), measure red blood cell levels.
These tests can reveal anemia (low red blood cells) or polycythemia (high red blood cells), both of which may signal kidney problems. Blood tests also check how well the kidneys are working.
Urinalysis checks for blood, bacteria, or unusual cells in the urine. Sometimes, doctors look for cancer cells in the urine (urine cytology). These early tests can show problems that may need more studies.
Table: Common Lab Tests for Kidney Cancer Suspicions
| Test | What It Checks For |
|---|---|
| Complete Blood Count | Anemia or polycythemia |
| Kidney Function | How well kidneys filter waste |
| Urinalysis | Blood, bacteria, or cancer cells in urine |
| Urine Cytology | Signs of cancer cells in urine |
Imaging Scans for the Kidneys
Doctors use imaging scans to find and diagnose kidney tumors. These machines take pictures inside the body. Imaging scans can show where the tumor is, its size, and if other areas are involved.
Types of Imaging Used:
- Ultrasound: Doctors use sound waves to make images. They often use this scan first to check for kidney growths.
- Computed Tomography (CT) Scan: CT scans make clear images of the kidneys. They can show tumors, their exact location, and if cancer has spread.
- Magnetic Resonance Imaging (MRI): MRI uses magnets and radio waves to create images. This helps doctors see if the tumor is near blood vessels or other organs.
- X-rays: Doctors may order chest x-rays to check if cancer has spread to the lungs.
- Bone scans: Doctors may do bone scans if there is a risk the cancer has spread to the bones.
Imaging also shows if veins or nearby structures are involved. It can help find possible spread to lungs, lymph nodes, or bones.
Taking a Tissue Sample (Biopsy)
Doctors may need to do a biopsy to confirm kidney cancer. They use a thin, hollow needle to take a small piece of kidney tissue. A lab checks the tissue under a microscope for cancer cells.
Doctors may do a biopsy if imaging does not give clear answers. If scans show enough information, a biopsy is not always needed.
The biopsy can help doctors find the exact type of kidney cancer, such as renal cell carcinoma or urothelial carcinoma. It can also rule out other diseases, like bladder cancer.
Steps in a Needle Biopsy
- Doctors use an imaging scan to guide the needle.
- They place the needle into the tumor or suspicious area.
- They remove a tissue sample.
- The lab looks at the sample for signs of cancer.
Determining How Far Cancer Has Spread
After finding kidney cancer, doctors need to know how much it has grown or spread. This is called cancer staging.
Staging shows if the cancer is only in the kidney or if it has reached other parts of the body. This information helps guide treatment.
Staging Tools and Methods:
- Doctors may use more CT or MRI scans to look for spread to veins, lymph nodes, lungs, and other organs.
- Sometimes, they order a chest x-ray or bone scan, especially if symptoms or earlier tests suggest possible spread.
The staging system for kidney cancer usually goes from Stage 1 to Stage 4:
| Stage | What It Means |
|---|---|
| 1 | Small tumor, only in the kidney |
| 2 | Larger tumor, but still only in the kidney. |
| 3 | Tumor spread to nearby major vein or lymph nodes. |
| 4 | Tumor has spread to other organs or distant body areas. |
Doctors use the stage to choose the most effective treatment plan.
Key Points on Staging:
- Staging helps plan treatment.
- Staging tests look at tumor size, location, and possible spread.
- Doctors combine information from blood tests, imaging, and sometimes biopsy to decide the stage.
Treatment
Surgical Options
Doctors often treat kidney cancer with surgery, especially when the cancer is limited to the kidney. There are two main types of surgery:
| Surgery Type | What It Removes | Benefits | Main Risks |
|---|---|---|---|
| Radical Nephrectomy | Entire kidney & tissue | Often needed for large tumors | Loss of kidney function |
| Partial Nephrectomy | Tumor & small margin | Preserves more kidney tissue | Possible technical challenges |
- Complete Kidney Removal (Radical Nephrectomy): Surgeons remove the entire kidney and some surrounding tissue, such as lymph nodes or part of the adrenal gland. They can do this through an open incision or with minimally invasive methods like laparoscopic or robotic surgery.
- Kidney-Sparing Surgery (Partial Nephrectomy): Surgeons remove only the tumor and a thin rim of healthy tissue. This approach helps preserve kidney function, which is important for people with only one kidney or small tumors.
Doctors choose the type of nephrectomy based on the tumor size, location, kidney function, and the patient’s overall health.
Freezing Therapy (Cryoablation)
Doctors use cryoablation to freeze and kill cancer cells. They guide a thin needle into the tumor with imaging tools like ultrasound.
Cold gas flows through the needle, freezing the area and destroying cancer cells. Doctors often use this method for small tumors or when surgery is too risky.
Tumor Heating Technique (Radiofrequency Ablation)
Radiofrequency ablation kills cancer cells by heating them. Doctors place a probe through the skin and into the kidney tumor using imaging for guidance.
An electric current heats the probe, which burns and destroys the cancer cells. This method works best for small kidney tumors and for people who cannot have regular surgery.
High-Energy Beam Therapy (Radiation Treatment)
Radiation therapy uses strong energy rays to destroy cancer cells. Patients lie on a table while a machine delivers precise radiation to the area with kidney cancer.
Doctors may use radiation to shrink tumors or relieve symptoms if cancer spreads to other parts of the body, such as bones or the brain.
Usually, doctors do not use radiation therapy as the first treatment for kidney cancer. It can help with symptom relief and local control when surgery is not possible.
Precision Medicine (Targeted Treatment)
Doctors use targeted treatments to block certain molecules in cancer cells that help them grow. These medicines can shrink the cancer or stop it from growing.
Patients often take these medicines by mouth or through a vein. Targeted treatment is helpful when kidney cancer has spread or cannot be removed by surgery.
Common features of targeted therapy:
- Targets specific proteins or genes in cancer cells.
- May cause side effects like high blood pressure, fatigue, or mouth sores.
- Usually part of treatment plans for advanced cancer.
Immune System Therapy (Immunotherapy)
Immunotherapy helps the body’s immune system find and attack cancer cells. Kidney cancer sometimes hides from the immune system, but these drugs help immune cells target and destroy the cancer.
Doctors may give immunotherapy after surgery to remove any remaining cancer cells or for tumors that have spread. These treatments can be used alone or with other medicines.
Immune treatments may include:
- Immune checkpoint inhibitors
- Interleukin-2 (IL-2) and similar agents
Doctors use these treatments for kidney cancer that is not limited to the kidney.
Medicine-Based Cancer Therapy (Chemotherapy)
Chemotherapy uses strong medicines to kill cancer cells. Doctors usually give these drugs by injection into a vein, but some are taken by mouth.
Kidney cancer often does not respond well to chemotherapy. Doctors may try it for rare types or if other treatments do not work.
Typical features of chemotherapy:
- Used less often for standard kidney cancers
- More effective for rare kidney cancer types
- Involves treatment that affects the whole body
Symptom Management and Comfort (Supportive Care)
Supportive care helps people with advanced or hard-to-treat kidney cancer feel better. The care team focuses on relieving symptoms like pain, fatigue, or shortness of breath.
Doctors, nurses, and other trained staff work together to provide the best care. Supportive care can:
- Reduce side effects from treatment.
- Control pain and relieve symptoms.
- Support emotional and practical needs for patients and families.
Complementary Therapies
Many people with kidney cancer use alternative treatments along with standard medical care. These treatments do not cure cancer but can help manage symptoms and side effects.
Some options that may support well-being:
- Acupuncture
- Massage therapy
- Art therapy
- Meditation
- Music therapy
- Relaxation exercises
- Spiritual practices
- Physical activity
These approaches may reduce stress, help with sleep, and improve mood. People should talk to their healthcare team before starting any new therapy.
Ways to Cope and Find Support
Understanding Your Diagnosis for Informed Choices
Learning about kidney cancer helps people take part in their care. It is important to ask questions about test results, treatments, and what to expect.
Having this information makes it easier to talk with the care team and make decisions. Keeping a chart or notebook can help organize important details from doctor visits.
| Tips for staying informed |
|---|
| Write down questions. |
| Keep a file of medical records. |
| Ask the care team for updates. |
Leaning on Family and Friends for Help
Support from friends and family helps during treatment. Loved ones can drive to appointments, prepare meals, or help with daily tasks.
They also provide emotional support during hard times. Staying connected helps when facing symptoms like weight loss or appetite changes.
Ways family and friends can help:
- Answer phone calls and messages.
- Bring healthy snacks.
- Offer encouragement.
Sharing Feelings with a Supportive Listener
Talking about feelings is important for people with cancer. Some find it helpful to talk with a trusted friend or family member.
Others may want to speak with counselors, social workers, or join support groups. These resources can help manage worries and cope with changes.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Planning for your healthcare visit ahead of time helps make the appointment more productive and less stressful.
Consider the following actions:
Ask about pre-visit steps. When you schedule your appointment, ask if you need to follow any special instructions. You may need to fast, avoid certain foods, or stop taking specific medicines.
Write down your symptoms. List all your signs and symptoms, even if they seem unrelated. Include details like blood in urine, pain in your side, unexplained weight loss, or high blood pressure.
Bring details about your health. Make a list of your current medicines, vitamins, and supplements with their dosages. Note your past medical history, especially kidney problems, high blood pressure, or tobacco use.
Be ready to share lifestyle factors. Tell your doctor if you currently smoke or have smoked in the past.
Know your family history. Write down if any relatives have had cancer. Some kidney cancers run in families.
Ask someone to come with you. Bring a friend or family member to help you remember what the doctor says.
Prepare questions. Make a list of questions for your doctor or specialist.
Hereโs a sample:
| Question | Reason |
|---|---|
| Do I have kidney cancer? | Understanding diagnosis |
| What stage is the cancer? | Knowing how advanced it is |
| Has it spread elsewhere? | Learning about disease progression |
| What treatments are available? | Exploring therapy choices |
| What are the risks/side effects? | Preparing for treatment impact |
| Should I see another specialist? | Considering a second opinion |
| Are there educational links or brochures? | Gathering more information |
- Write your questions from most to least important. This helps make sure your top concerns are addressed first.
- Be open about lifestyle. Tell your doctor about risk factors like smoking, high blood pressure, or a family history of cancer.
Questions the Doctor Might Ask You
Doctors need detailed information to help decide on the best next steps. A urologist, oncologist, or other specialist might ask you questions such as:
When did your symptoms start?
Are your symptoms constant, or do they come and go?
How strong are your symptoms?
Have you noticed anything that eases or worsens them?
Are you currently or have you been a smoker?
Do you have a history of high blood pressure or other health conditions?
Have you had any recent significant stress or life changes?
Have there been changes in your urine, such as blood or pain?
Your doctor may ask about your use of tobacco, your past medical issues, and any family history of kidney or other cancers. Bring written notes and lists to help you give clear answers and remember important details during your appointment.
