Kidney Mass Workup

General information about kidney masses and renal cell cancer
  • Not all kidney masses are cancerous, but most need evaluation by a urologist (specialized surgeon)
  • Renal cell cancer is a disease in which malignant (cancer) cells form in tubules of the kidney
  • Smoking and misuse of certain pain medicines can affect the risk of renal cell cancer
  • Signs of renal cell cancer include blood in the urine and a lump in the abdomen
  • Tests that examine the abdomen and kidneys are used to diagnose renal cell cancer
  • Certain factors affect prognosis (chance of recovery) and treatment options
What is kidney cancer?

Renal cell cancer (also called kidney cancer or renal cell adenocarcinoma) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body. 

normal genitourinary anatomy
Anatomy of the male urinary system (left panel) and female urinary system (right panel) showing the kidneys, ureters, bladder, and urethra. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.
Smoking and misuse of certain pain medicines can affect the risk of renal cell cancer. 

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for renal cell cancer include the following:

  • Smoking.
  • Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.
  • Being overweight.
  • high blood pressure.
  • Having a family history of renal cell cancer.
  • Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.
Signs of renal cell cancer include blood in the urine and a lump in the abdomen.

These and other signs and symptoms may be caused by renal cell cancer or by other conditions. There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows. Check with your doctor if you have any of the following:

  • Blood in the urine
  • A lump in the abdomen
  • A pain in the side that doesn’t go away
  • Loss of appetite
  • Weight loss for no known reason
  • Anemia
How is kidney cancer diagnosed?
  • Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  • Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the abdomen and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. 
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). 
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. To do a biopsy for renal cell cancer, a thin needle is inserted into the tumor through the skin and a sample of tissue is taken. Biopsy is usually not necessary to make a diagnosis of kidney cancer. 
  • Nephrectomy: Nephrectomy is a surgery to remove a part or the entire kidney. Very often, in patients who have a high likelihood for kidney cancer, the urologist will recommend a nephrectomy instead of a biopsy. This helps not only diagnose but treat the cancer in one procedure.
Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

  • The stage of the disease.
  • The patient’s age and general health.
How is the stage of kidney cancer determined?
  • After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body. 
  • There are three ways that cancer spreads in the body.
  • Cancer may spread from where it began to other parts of the body.
  • The following stages are used for renal cell cancer:
    • Stage I
    • II
    • III
    • IV
  • Renal cell cancer can recur (come back) many years after initial treatment.
After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body. 

The process used to find out if cancer has spread within the kidney or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

  • CT scan (CAT scan): Because kidney cancer can spread to other body parts, CT scans of chest and other areas may be performed as part of your “staging workup”
  • MRI (magnetic resonance imaging): May be performed under certain circumstances
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

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DISCLAIMER: No part of this content constitutes medical advice, opinion, or should be used for medical decision making without consultation with a licenced medical practitioner and under a patient-provider relationship. All information on the website is provided without any claims of accuracy. For full terms and conditions, visit this link. Content curated by the Ankr team.

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