Diagnosing kidney cancer
This information is an extract from the booklet Understanding
kidney cancer. You may find the full booklet helpful. We can
send you a free copy – see page 7.
Contents
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How kidney cancer is diagnosed
Staging
Number staging
Grading
How kidney cancer is diagnosed
Often people are diagnosed by chance after having a scan
for another reason. Some people go to see their family doctor
(GP) with symptoms, such as blood in their urine.
If you have blood in your urine (haematuria), your GP may
refer you to a ‘one-stop’ haematuria clinic. At this clinic, all
the tests needed to make a diagnosis can often be done at
the same time.
If tests or symptoms suggest you could have a kidney cancer,
you should be seen by a specialist within 14 days.
At the hospital
You’ll see a urologist or a specialist nurse who will ask you
about your symptoms and general health. They’ll also examine
you and arrange some of the following tests.
Blood tests
You will have blood samples taken. These help your doctors
to check how well your kidneys and liver are working. They
also show the number of blood cells in your blood. This is
called a blood count.
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Diagnosing kidney cancer
Ultrasound scan
This test can help to diagnose kidney cancer. It uses sound
waves to build up a picture of the kidneys, ureters and bladder.
It’s a painless test and only takes a few minutes.
If your bladder is to be looked at as well, you will need to
have a full bladder for the scan. The hospital will give you
instructions about this. You lie on your back and the person
doing the ultrasound spreads gel over your tummy (abdomen)
area. They then move a small device, which produces sound
waves, over your tummy. A computer turns the sound waves
into a picture.
Ultrasound can look for changes in the shape of the kidneys.
It can help to show if a lump is a cyst (a fluid-filled lump)
or a tumour. It can also show the position of a cancer and
measure its size.
CT (computerised tomography) scan
This test is used to check the kidneys and organs in the tummy
area (abdomen) and chest.
A CT scan takes a series of x-rays, which build up a
three‑dimensional picture of the inside of the body. The scan
takes 10–30 minutes and is painless. It uses a small amount
of radiation, which is very unlikely to harm you and will not
harm anyone you come into contact with. You will be asked
not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye, which allows
particular areas to be seen more clearly. This may make you
feel hot all over for a few minutes. It’s important to let your
doctor know if you are allergic to iodine or have asthma,
because you could have a more serious reaction to the
injection.
You’ll probably be able to go home as soon as the scan is over.
MRI (magnetic resonance imaging) scan
Some people have an MRI scan instead of, or as well as,
a CT scan.
This test uses magnetism to build up a detailed picture of
areas of your body. The scanner is a powerful magnet so you
may be asked to complete and sign a checklist to make sure
it’s safe for you. The checklist asks about any metal implants
you may have, such as a pacemaker, surgical clips or bone pins.
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Diagnosing kidney cancer
You should also tell your doctor if you’ve ever worked with
metal or in the metal industry as very tiny fragments of
metal can sometimes lodge in the body. If you do have any
metal in your body, it’s likely that you won’t be able to have
an MRI scan. In this situation, another type of scan can be
used. Before the scan, you’ll be asked to remove any metal
belongings including jewellery.
Some people are given an injection of dye into a vein in the
arm, which doesn’t usually cause discomfort. This is called
a contrast medium and can help the images from the scan
to show up more clearly. During the test, you’ll lie very still
on a couch inside a long cylinder (tube) for about 30 minutes.
It’s painless but can be slightly uncomfortable, and some
people feel a bit claustrophobic. It’s also noisy, but you’ll be
given earplugs or headphones. You can hear, and speak to,
the person operating the scanner.
Chest x-ray
If you don’t have a CT scan of the chest, you will have a chest
x-ray to check the health of your lungs.
Guided biopsy
This is done if you need to have a sample of tissue taken from
the kidney (a biopsy). The doctor uses an ultrasound scanner
or CT scanner to guide them to the exact area of kidney
where the biopsy will be taken.
The doctor injects some local anaesthetic into the skin to
numb the area over the kidney. They then guide the needle
through your skin into the kidney. And, they draw a small
sample of tissue into the needle. The sample is then sent to
the laboratory to be checked.
You may need to stay in hospital for a few hours, or overnight,
after this procedure.
Waiting for test results
Waiting for test results can be a difficult time. It may take from
a few days to a couple of weeks for the results of your tests to
be ready. You may find it helpful to talk with your partner, your
family or a close friend. You can also talk things over with one
of our cancer support specialists on 0808 808 00 00.
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Diagnosing kidney cancer
Staging
The stage of a cancer describes its size and whether it has
spread. Once your doctors know the stage of the cancer, they
can plan your treatment.
The structure of the kidneys
Adrenal gland
Lymph
nodes
Fat layer
Capsule
Medulla
Renal vein
(to vena cava)
Renal artery
Kidney
Cortex
Ureter
The most commonly used staging system for kidney cancer
is the TNM system:
T refers to the tumour size.
N refers to whether lymph nodes are affected.
M refers to whether the cancer has spread to other parts of
the body (metastases).
Tumour size (T)
T1 – The cancer is only in the kidney and is no larger than 7cm.
•T1a – The cancer is no larger than 4cm.
•T1b – The cancer is larger than 4cm but not larger than 7cm.
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Diagnosing kidney cancer
T2 – The cancer is larger than 7cm and is inside the kidney.
T3 – The cancer is growing into the fat around the kidney or
into a major vein (the vena cava and renal vein) close to the
kidney. But it is not growing beyond the outer covering of the
kidney (capsule). See page 11 for an illustration of the kidney.
T4 – The cancer has spread outside the capsule that surrounds
the kidney. It may have grown into the adrenal gland.
Lymph nodes (N)
N0 – There are no cancer cells in any lymph nodes.
N1 – There are cancer cells in one or more lymph nodes.
If the cancer cells have spread to the lymph nodes, the nodes
are said to be positive.
Metastases (M)
M0 – The cancer has not spread to other distant parts of
the body.
M1 – The cancer has spread to distant parts of the body such
as the bones, lungs, liver or brain. If the cancer has spread,
it’s called secondary or metastatic kidney cancer.
Number staging
The T, N and M stages may be grouped together to give
a number stage for the cancer. These range from stages 1–4.
Stage 1
The cancer is 7cm or less and is inside the kidney. There is
no spread to the lymph nodes or other organs. This is the
same as T1 N0 M0 in the TNM system.
Stage 2
The cancer is larger than 7cm and is inside the kidney. There
is no spread to the lymph nodes or other organs. This is the
same as T2 N0 M0 in the TNM system.
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Diagnosing kidney cancer
Stage 3
The cancer is growing into the fat around the kidney or into
one of the major veins close to the kidney (the renal vein or
the vena cava) but has not grown outside the capsule that
surrounds the kidney. It has not spread to the lymph nodes.
This is the same as T3 N0 M0 in the TNM system.
Or the cancer has spread to the lymph nodes but has not
grown outside the capsule around the kidney. This is the same
as T1–T3 N1 M0 in the TNM system.
Stage 4
The cancer has grown through the capsule that surrounds the
kidney and may have grown into the adrenal gland. It may
have spread to the lymph nodes. It has not spread to parts
of the body far from the kidney. This is the same as T4 Any N
M0 in the TNM system.
Or the cancer has spread to distant parts of the body. It
can be any size and may have grown through the capsule
surrounding the kidney and may have grown into the adrenal
gland. It may have spread to the lymph nodes. This is the
same as T1–T4 Any N M1 in the TNM system.
Grading
Grading refers to the appearance of the cancer cells under
the microscope. The grade gives an idea of how the cancer
may behave.
The Fuhrman system is the most common grading system for
kidney cancer. It ranges from 1–4; the higher the number,
the more abnormal the cells look. A grade 1 cancer is usually
slow‑growing. It is less likely to spread than a higher grade,
such as a grade 4 cancer.
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Diagnosing kidney cancer
More information and support
More than one in three of us will get cancer. For most of us
it will be the toughest fight we ever face. And the feelings
of isolation and loneliness that so many people experience
make it even harder. But you don’t have to go through it alone.
The Macmillan team is with you every step of the way.
To order a copy of Understanding kidney cancer, or
any other cancer information, visit be.macmillan.org.uk
or call 0808 808 00 00.
We make every effort to ensure that the information we provide is accurate and up to
date but it should not be relied upon as a substitute for specialist professional advice
tailored to your situation. So far as is permitted by law, Macmillan does not accept
liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. © Macmillan Cancer Support
2013. Registered charity in England and Wales (261017), Scotland (SC039907) and the
Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ
REVISED IN JUNE 2015
Planned review in 2017
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