Symptoms of kidney cancer

Kidney cancers don't always cause symptoms. It is becoming increasingly common for kidney cancer to be diagnosed by chance when people are having scans done for some other reason. The kidney cancers found in this way are often small and because of this don't cause any symptoms.If there are symptoms, these may include:

• Blood in the urine. This is the most common symptom of kidney cancer. It may come and go, but, if you ever see blood in your urine you should always get it checked out.
• Painful spasms in the ureters or the bladder caused by blood clots.
• A lump in the area of the kidney.
• A dull pain in the side.
• A persistent high temperature, night-sweats, tiredness and weight loss.

Most people with these symptoms won't have kidney cancer. Other more common conditions such as an infection or stones in the bladder or kidneys are often the cause. But, if you develop any of these symptoms, it's important to get them checked by your doctor.

How kidney cancer is diagnosed

Usually, you begin by seeing your family doctor (GP). They will ask for a sample of your urine, and may also take a blood sample for testing. Depending on the results of these tests, your GP will refer you to a hospital for expert advice and treatment.

If you have blood in your urine (haematuria) you may be referred to a „one stop' haematuria clinic. At this kind of clinic, all the tests needed to make a diagnosis can often be carried out at the same time and you can go home the same day. You may be asked not to eat or drink anything for up to eight hours before your appointment.

Further tests for kidney cancer

At the hospital the doctor will ask you about your symptoms and general health. You will also be asked if you have any other health problems. The doctor will examine you physically and arrange for some of the following tests:

IVU or IVP (intravenous urogram)

This test shows up anything unusual in the kidneys or urinary system. It is done in the hospital x-ray department and takes about an hour.

A dye is injected into a vein in your arm, and travels through the bloodstream to the kidneys. The doctor can watch on a screen how the dye passes through the kidneys and can pick up any problems.

The dye will probably make you feel hot and flushed for a few minutes but this feeling goes away after a short time.

Ultrasound scan

This test can be very helpful in diagnosing cancer of the kidney. It uses sound waves to build up a picture of the inside of the tummy (abdomen) including the kidneys. It is a painless test and only takes a few minutes. Once you are lying comfortably on your back, a gel is spread onto your abdomen. A small device, which produces sound waves, is rubbed over the area. The echoes are turned into a picture by a computer.

Ultrasound can be used to look for changes in the shape of the kidneys, which may suggest there is a cyst or tumour. It can also measure the size and position of a cancer.

CT scan

A CT (computerised tomography) scan takes a series of x-rays and puts these together to give a 3-D picture of the inside of your body. The scan is painless and takes between 10 and 30 minutes. It may be used to look for changes in the kidneys, to identify the exact site of the tumour, or to check for any spread of the disease. You may be asked not to eat or drink anything for several hours before your appointment.

Most people who have a CT scan are given a drink or injection of dye before the scan. This helps the doctor to see particular areas more clearly. People who are allergic to iodine or have asthma may be at higher risk of reacting to the dye. So, if you are allergic to iodine or have asthma, tell the doctor and the person doing the test before you have the injection or drink. After having the injection, most people feel hot and flushed but this only lasts for a few minutes. You will probably be able to go home as soon as the scan is over.

Cystoscopy

This test may be done if you have blood in your urine. It doesn't look at the kidneys but is used to check the bladder lining for signs of bleeding. It is usually done under local anaesthetic and takes about 20 minutes. A small, flexible, fibre-optic tube with a light at the end (cystoscope) is passed into the tube that leads to the bladder (urethra). This allows the doctor to look at the whole lining of the bladder and urethra.

You may have some soreness or mild pain when you pass urine for the first time after the test. However, there are not usually any other effects.

MRI scan

An MRI (magnetic resonance imaging) scan is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body.

Having an MRI scan

During the test you will be asked to lie very still on a couch inside a long tube for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It is also noisy, but you will be given earplugs or headphones. You may be able to take someone with you into the room to keep you company.

The scanner is a very powerful magnet, so you should remove any metal belongings before entering the room. People who have heart monitors, pacemakers or certain metallic surgical clips cannot have an MRI because of the magnetic fields.

Some people are given an injection of dye into a vein in the arm to show the kidneys better.

Image-guided biopsy

This may be done if you need to have a sample of tissue – a biopsy – taken from the kidney. A doctor uses an ultrasound or CT scanner to guide them to the area of kidney where the biopsy will be taken. This is known as an ultrasound- or CT-guided biopsy.

Before the scan, a local anaesthetic is injected to numb the area over the kidney. The kidney is then scanned to produce pictures on a screen. This helps the doctor to accurately guide a needle through the skin and into the kidney. The doctor draws a small sample of tissue into the needle before removing it. This sample will be sent to the laboratory to be examined under a microscope. You may need to stay in hospital for a few hours (or overnight) after this procedure.

Blood tests

You will usually have blood tests taken to assess your general health.

Chest x-ray

X-rays are often taken to check the health of your heart and lungs.

Waiting for your test results

It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you can talk things over with a relative or close friend. You could also contact one of the support organisations.

Staging and grading of 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 decide on the most appropriate treatment for you. The most commonly used staging system for kidney cancer is called 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)

• T1a The cancer is smaller than 4cm in size and limited to the kidney
• T1b The cancer is between 4cm and 7cm in size and is limited to the kidney
• T2 The cancer is larger than 7cm but is still limited to the kidney.
• T3 The cancer is growing into the adrenal gland OR into the fat around the kidney but not beyond the fibrous tissue (Gerota's fascia) OR into one or both large blood vessels close to the kidney (renal artery and renal vein).
• T4 The cancer has spread outside the fibrous envelope of tissue (Gerota's fascia) that surrounds the kidney.

Lymph nodes (N)

The N refers to whether the cancer cells have spread into the lymph nodes close to the kidney. There are three lymph node stages. These are:

• N0 There are no cancer cells in any lymph nodes.
• N1 There are cancer cells in one lymph node.
• N2 There are cancer cells in two or more lymph nodes

If the cancer cells have spread to the lymph nodes, the nodes are said to be positive.

Metastases (M)

If the cancer cells have not spread, this is described as M0.

If cancer cells have spread to other parts of the body it is said to be M1. If kidney cancer spreads it is most likely to go to the bones, the lungs, the liver or the brain. If the cancer has spread it is called secondary or metastatic kidney cancer.

The T, N and M stages may be grouped together to give an overall stage for the cancer from 1–4.

• Stage 1 The cancer is smaller than 7cm and is limited to the kidney. There is no spread to lymph nodes or other organs.
• Stage 2 The cancer is larger than 7cm and is limited to the kidney. There is no spread to lymph nodes or distant organs.
• Stage 3 The cancer has begun to spread outside the kidney. It may have spread into the adrenal gland, which sits on top of the kidney, OR to one of the large blood vessels close to the kidney (the renal vein or the vena cava) OR to only one lymph node OR into the fat that surrounds the kidney.
• Stage 4 The cancer has grown through the fibrous tissue outside of the kidney, and/or has spread to two or more lymph nodes and/or has spread to other organs.

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 goes from 1– 4: the higher the number, the more abnormal the cells look. A grade 1 cancer will usually grow more slowly and be less likely to spread than a higher grade cancer such as a grade 4 cancer.