Kidney cancer (Renal cancer) is a condition in which one or more cancerous tumors develop in one or both kidneys. Over time, the tumors grow in size and can invade surrounding tissues. In its more advanced stages, renal cancer can metastasize (spread throughout the body), causing tumors to develop in other organs.

Primary renal cancer refers to cancerous tumors that originate in the kidney. The kidneys can also develop metastatic or secondary tumors as a result of cancer spreading from some other part of the body. There are several types of primary renal cancer but renal cell carcinoma is the most common. Renal cell carcinomas (RCCs) comprise 80 to 85 percent of all renal cancers.  The classic presenting symptoms of RCC are hematuria (blood in the urine), flank pain (pain in the side at the level of the lower ribcage), and an abdominal mass. However, most cancers do not produce pain, and many patients with primary RCC experience no symptoms until the disease is advanced. An increasing percentage (up to 40 percent) of patients are diagnosed with RCC incidentally, based upon a radiologic procedure such as ultrasound or CT scan that was performed for other reasons.

Surgery plays a large role in renal cell carcinoma, and in more advanced cases, chemotherapy and/or biologic therapy are also utilized.

When a diagnosis of kidney cancer is made, necessary tests are done to determine the “stage” of your cancer. Treatment for kidney cancer depends upon its stage, which indicates how far the cancer has spread within the body. Renal cancer is usually staged according to the system known as TNM (tumor, node, metastasis), in which the cancer is characterized by its extent within the kidney itself (tumor or T stage), whether the lymph nodes in the region are involved with cancer (node or N stage), and whether the cancer has metastasized to other parts of the body (metastasis or M stage).

We have listed various tests, items, and consults you may need to determine your treatment plan:

1. Tissue biopsy. A small portion of tissue is obtained by using a thin needle. The tissue (or cells) is then examined by the pathologist to determine if it contains cancer. Most patients with suspected RCC do not require a biopsy: surgery to remove the entire tumor is usually performed in lieu of biopsy even in patients with advanced or metastatic disease.
2. CT scan of the chest/abdomen/pelvis. This type of X-ray evaluates the kidney and lymph nodes and looks for spread disease.
3. MRI abdomen. This is sometimes also used to evaluate the kidney and lymph nodes prior to surgery.
4. Bone scan. This type of X-ray evaluates for renal cancer in the bones.
5. Brain MRI. In cases of advanced cancer, this is used to evaluate for metastases in the brain.
6. Urology consult. Urologists are surgical experts in kidney cancer.
7. Medical oncology consult. Medical oncologists are experts in kidney cancer and can administer chemotherapy and biologic therapy. Clinical trials may also be available as additional treatment options.
8. Blood tests. Your blood will be drawn to evaluate your blood counts, kidney function, and liver function (CBC—complete blood count and CMP—comprehensive metabolic panel). LDH is a blood test that should be drawn prior to surgery as well.

Websites:

www.mayoclinic.com/health/kidney-cancer/DS00360

www.cancer.gov/cancerinfo/wyntk/kidney

Resources:
www.uptodate.com