Renal Cell Cancer (cont.)
When to Seek Medical Care
Contact a health care provider if any of the following symptoms occur:
- Blood in the urine
- Pain in the side that will not go away
- A lump in the side or belly
- Unexplained fevers
- Weight loss
- Night sweats
If any unexplained symptoms last more than a few days, or if a person just "doesn't feel right," make an appointment with a health care professional.
Do not ignore these symptoms or just hope that they will just go away if they are persistent or worsening. They may not be cancer, but if they are, an early diagnosis is better. The earlier a cancer is diagnosed and treated, the better the chances are of a full recovery.
Exams and Tests for Renal Cell Cancer
Only 10% of people with renal cell cancer have the classic specific symptoms, such as blood in the urine, or a lump or pain in the side. Other people have no symptoms or only vague, nonspecific symptoms, such as fatigue or just not feeling well. Still others have no symptoms at all. A health care provider will gather many different types of information to make a diagnosis. This process includes ruling out conditions that cause similar symptoms. If urinary symptoms occur, referral to a urologist (a surgical doctor who specializes in diseases of the urinary tract) may be necessary.
The following steps may be taken for a health care provider to make a correct diagnosis:
- Medical interview or history: A health care provider asks questions about the symptoms and how they started, current and previous medical problems, medications, family history, work and travel history, and habits and lifestyle.
- Physical exam: This exam is performed to look for abnormalities that suggest a cause of the symptoms.
- X-rays, a CT scan, an MRI, and lab tests: These studies are usually performed after the interview and physical exam. If the results suggest that renal cell cancer or another cancer may be present, referral to a surgeon, a radiologist, and/or an oncologist (a doctor who specializes in cancer) may be needed.
- Biopsy: A biopsy involves taking a small sample of the tumor. The sample is usually removed via a large needle inserted into the tumor. The sample is examined by a pathologist (a doctor who specializes in diagnosing diseases in tissues and body fluids). Cancer cells in the biopsy sample confirm the diagnosis of cancer. If the diagnosis of kidney cancer is strongly suspected based on X-ray/CT scan studies, biopsies of the kidney are not always done because of the risk of bleeding. The definitive diagnosis of kidney cancer is made at the time of surgery to remove the kidney (nephrectomy).
- Staging: Another series of imaging studies and lab tests are performed to learn more details about the cancer and whether it has spread to other parts of the body. Careful staging is extremely important for planning treatment and predicting the course of the disease.
A number of imaging studies are used to evaluate and stage renal masses.
- Intravenous pyelogram (IVP): This study is also called excretory urography. A series of X-rays are taken of the kidneys, ureters, and bladder after a dye is injected into the bloodstream via a vein. The dye allows a much clearer and more detailed image of these organs than a regular X-ray. This study shows less detail than newer scans such as a CT scan and an MRI.
- Arteriography/venography: This study is a series of X-rays of the blood vessels in and around the kidneys after injection of a harmless dye into the bloodstream. Like IVP, this study shows less detail than CT scans and MRIs.
- Ultrasonography: This method uses sound waves (ultrasound) to create an image of the kidneys and surrounding tissues. This safe technique is the same method used to look at a fetus in a mother's womb. This method shows the difference between tumors and other abnormalities such as cysts.
- Computed tomography (CT scan): This study is like an X-ray but shows greater detail than an X-ray and gives a 3-dimensional view of the kidneys and surrounding organs. CT clearly shows the difference between abnormal and normal tissues, and it also shows enlarged lymph nodes.
- Magnetic resonance imaging (MRI): An MRI shows even more detail than a CT scan and shows if areas around the kidneys are affected by the tumor, especially blood vessels.
- Positron emission tomography (PET): This study is recent technology that can show how tissues metabolize sugar. Because cancers take up and metabolize sugar differently than normal tissue, PET imaging can be useful in defining abnormal areas on a CT scan or an MRI. It is an expensive test and its utility in this type of cancer in controversial.
- Bone scan: A bone scan is recommended for anyone with renal cell carcinoma who has bone pain, other test results, or other symptoms that suggest bone involvement. A chest X-ray or a CT scan can detect cancer spread to the lungs.
The following lab tests are performed to look for paraneoplastic syndromes, to rule out other conditions, and to evaluate a person's overall health before beginning treatment.
- Urine analysis
- Blood tests - Blood cell counts, chemistry, liver and kidney function tests, erythrocyte sedimentation rate, and prothrombin time and activated partial thromboplastin time (clotting studies) also called PT and PTT.
Medically Reviewed by a Doctor on 12/14/2015
Koyamangalath Krishnan, MD, FRCP
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