Kidney Helpline
Kidney Health Australia
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Overview
If your doctor suspects you have kidney cancer, you may have blood and urine tests, imaging scans such as an ultrasound or CT scan, and a tissue biopsy, where doctors remove a sample of cells.
The tests will help the doctors see how big the cancer is and how far it has spread (staging). They will also see how similar the cells look to normal cells and how fast they are growing (grading). In Australia, the Fuhrman system and the newer International Society of Urological Pathology (ISUP) system are used to grade kidney cancer.
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Tests
Most kidney cancers are found by chance when a person has an ultrasound or another imaging scan for an unrelated reason. If your doctor suspects kidney cancer, you may have some of the following tests, but you are unlikely to need them all.
Blood and urine tests
You will probably have urine and blood tests to check your general health and look for signs of a problem in the kidneys.Imaging scans
Imaging scans can create pictures of the inside of your body and provide different types of information. You may have an ultrasound, CT scan, MRI scan, radioisotope bone scan or PET scan.Tissue biopsy
A biopsy is when doctors remove a sample of cells or tissue from an area of the body. In kidney cancer, a biopsy is not always needed before treatment.Grading
By examining a sample of kidney tissue, doctors can see how similar the cancer cells look to normal cells and estimate how fast the cancer is likely to grow. This is called grading.
Grading helps the doctors decide what follow-up treatment you might need and whether to consider a clinical trial.
In Australia, both the Fuhrman system and the newer International Society of Urological Pathology (ISUP) system may be used to grade kidney cancer.
Both systems grade kidney cancer from 1 to 4, with grade 1 the lowest and grade 4 the highest. As the grade increases, the cancer cells look less similar to normal cells. Higher-grade cancers tend to be more aggressive than lower-grade cancers.
Staging
The stage of a cancer describes how large it is, where it is, and whether it has spread beyond the kidney. Knowing the stage of the kidney cancer helps doctors plan the best treatment for you.
The stage can be given before surgery (clinical staging), but may be revised after surgery (pathologic staging).
If you have kidney cancer, your doctor will use the results of these tests to assign a stage of 1 to 4 (see below):
- Stages 1–2 – are considered early kidney cancer
- Stages 3–4 – are considered advanced kidney cancer.
How kidney cancer is staged
How kidney cancer is staged
The most common staging system for kidney cancer is the TNM system, which stands for tumour–nodes–metastasis. This system gives numbers to the size of the tumour (T1–4), whether or not lymph nodes are affected (N0 or N1), and whether the cancer has spread or metastasised (M0 or M1). Based on the TNM numbers, the doctor then works out the cancer’s overall stage (1–4).
- Stage 1 (early) – The cancer is found in the kidney only and measures less than 7 cm.
- Stage 2 (early) – The cancer is larger than 7 cm, but has not spread outside the kidney.
- Stage 3 (locally advanced) – The cancer is any size and has spread to the major kidney veins, into the fat around the kidney, or to nearby lymph nodes.
- Stage 4 (advanced or metastatic) – The cancer has spread to surrounding tissue outside the kidney, to the adrenal gland or to more distant parts of the body (such as the distant lymph nodes, the liver, lungs, bone or brain).
Prognosis
Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. Your doctor can give you an idea about common issues that affect people with kidney cancer.
The stage of the cancer is the main factor in working out prognosis. In most cases, the earlier that kidney cancer is diagnosed, the better the chance of successful treatment. If the cancer has spread to other parts of the body, it is very unlikely that all of the cancer can be removed, but treatment can often keep it under control for some time.
People who can have surgery to remove kidney cancer tend to have better outcomes. Other factors such as your age, general fitness and medical history also affect prognosis.
Preparing for treatment
Talk with your doctors about whether you need to do anything to prepare for treatment and help your recovery.
They may suggest that you exercise, eat a healthy diet or drink less alcohol. You may also find it helpful to talk to a counsellor about how you are feeling.
If you smoke, you will be encouraged to stop. Research shows that quitting smoking before surgery reduces the chance of complications. To work out a plan for quitting, talk to your doctor or call the Quitline on 13 7848.
Preparing for treatment in this way – called prehabilitation – may improve your strength, help you cope with treatment side effects and improve the results of treatment.
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