So how do doctors diagnose kidney cancer. With most cancers there is no direct cause and kidney cancer is no exception. For many people the cause of the cancer is never found. However, certain lifestyle factors can increase the risk of developing the disease;
- The risk of developing kidney cancer is highest in people aged 45-75, and tails off in the late seventies.
- An unhealthy diet and being overweight (obesity) increases the risk of developing kidney cancer.
- Smoking may double the risk of developing kidney cancer for some people. The longer a person smokes and the more cigarettes they smoke, the greater the risk.
- Genetic factors, such as a mutation in the von Hippel-Lindau gene, Birt-Hogg-Dubé syndrome, tuberous sclerosis and hereditary clear cell and papillary renal cell cancer, put people at greater risk of developing the disease.
- Gender; men are twice as likely to suffer from kidney cancer than women.
- Family history; people with a first-degree-relative (parent, sibling or child) with kidney cancer have about double the risk of developing kidney cancer themselves.
- Certain medical conditions, such as high blood pressure (hypertension) and chronic kidney disease, especially people on long-term kidney dialysis, have a link to kidney cancer.
- Previous thyroid cancer increases the risk of kidney cancer, possibly due to genetic changes that are common to both types of cancer.
- Previous radiotherapy for testicular or cervical cancer (cancer of the neck of the womb) may slightly increase the risk of developing kidney cancer.
- Long term regular use of painkillers, such as ibuprofen, naproxen, phenacetin and celebrex is linked to kidney cancer.
Symptoms of kidney cancer
The most common symptom is blood in the urine. Doctors call this haematuria. It may come and go and not every kidney cancer sufferer will have haematuria. Sometimes you won’t be able to see it, but it can still be detected by a urine test. Most people with blood in their urine do not have kidney cancer. It can be a sign of an infection, kidney stones, prostate problems or bladder cancer. However, it should always be investigated to find out what has caused it.
Most kidney cancers are too small to feel, but if you feel a lump or mass in the area of your kidneys you should tell your doctor straight away. You should also see your doctor about any persistent low back pain, or pain in your side between your ribs and hipbone (sometimes called the flank or loin). The sooner kidney cancer is detected, the easier it is to treat.
In the early stages of kidney cancer there may be no obvious symptoms. Many kidney cancers are found simply by chance when someone is being given a scan for another reason. More than half of adult kidney tumours are detected when using an ultrasound scan to investigate symptoms, such as; high blood pressure, muscle wasting and weight loss, high temperature or fever, disorders affecting the nerves and muscles, inflammation, anaemia, abnormal liver function tests or high levels of calcium in the blood (hypercalcaemia).
Sometimes abnormal red blood cell counts and high blood pressure, or hypertension, can be symptoms of kidney cancer. Some patients experience a condition called polycythaemia, or thickening of the blood, which can also be a symptom of kidney cancer. Symptoms of polycythaemia are a bad headache and redness of the skin.
In about a third of patients, the kidney cancer will have already spread to other organs, such as the lungs, liver, brain and bones. These patients may experience symptoms of advanced kidney cancer, such as: a persistent cough, coughing-up blood (or haemoptysis), abnormal liver function tests, headaches and visual disturbances, or bone pain. You must see your doctor if you have any of these symptoms.
There are other symptoms, which can be more general and can also be caused by many other conditions, such as weight loss, tiredness, and running a persistent temperature and sweating heavily, especially at night.
Typical signs and symptoms of kidney cancer:
- Blood in the urine, also called haematuria
- Persistent low back pain or pain in the side between the ribs and hipbone
- A lump or mass in the area of the kidneys
- Abnormal red blood cell counts
- High blood pressure or hypertension
- Thickening of the blood (polycythaemia)
- Weight loss and/or loss of appetite
- Running a persistent temperature and sweating heavily, especially at night
How doctors diagnose kidney cancer
Currently, there are no effective screening programmes for kidney cancer in the UK. Doctors use their clinical experience, scans and various tests to identify kidney cancer.
At your GP surgery
Your family doctor will probably carry out some initial tests. He or she will ask about your general health, examine you and ask for a urine sample. This will be analysed to see if it contains blood. You may also be asked for a blood sample. This will be tested to see how well your kidneys are working. He or she may also perform a physical examination to check for any lumps or swelling; however, small tumours are difficult to detect on a physical examination because the kidneys are deep inside the body.
Your GP may then refer you to a hospital specialist for further tests, especially if you have blood in your urine. There are special referral guidelines for GPs to help them decide who needs to be referred to a specialist urgently.
The hospital specialist, usually an urologist, will want to know about your medical history and symptoms. If anyone else in the family has had kidney cancer you should mention this. You will have more blood and urine tests, such as a full blood count (FBC) and urea and electrolytes (U&Es), to test the function of your kidneys. If you want to know the results of your blood tests, please ask your doctor to explain them.
Your doctor will also want to look at your kidneys. Usually the first test he or she will do is an ultrasound scan, which is a real-time, moving test used to detect and differentiate between tumours and cysts on the kidney. This is a painless procedure that is done in the hospital scanning department and only takes a few minutes to perform. You lie down and gel is spread on your abdomen. A small probe, which produces sound waves, is rubbed over the area. The sound wave echoes are detected by the probe and turned into a picture of the organs and structures inside your body, by a computer.
If you have blood in your urine, your doctor might want to carry out a cystoscopy to check inside your bladder. The procedure can be done under local or general anaesthetic. A fine, flexible tube with a light in the end (called a cystoscope) is passed up your urethra and into your bladder, where it acts like a telescope allowing the doctor to see inside your bladder.
If the initial investigations confirm you have kidney cancer, you will need more tests to help doctors see if it has spread and how best to treat it. However, some of the following tests may also be used when your doctor is still trying to determine whether you have kidney cancer or not:
Computerised tomography (CT) is a special type of X-ray examination and is conducted in the X-ray department of the hospital. A CT scan is used to check the size of the tumour and whether it has spread to other organs, such as the lungs and the other kidney.
The CT scanning machine takes a series of X-ray pictures of your body from different angles. A computer puts these images together to give a detailed image of the inside of your body. You will need a full bladder for this examination, so you will not be able to go to the toilet beforehand. The machine is shaped rather like a ring doughnut. You lie on a couch, which slides backwards and forwards through the hole. The radiographer cannot stay in the room with you during the scanning, but will be able to see you on a TV screen and talk to you through an intercom. You may be given an injection of a special dye, or contrast agent, into a vein in your arm to help blood vessels show up more clearly. A CT scan is painless but takes longer than an X-ray. The length of the whole procedure depends on how many pictures are taken, but expect to be on the couch for about 30 minutes. Some people feel a little claustrophobic during a scan. If you think you might, tell the radiographers before the day of your appointment.
Doctors can usually make a confident diagnosis from a CT scan alone. Occasionally a biopsy will also be carried out. A thin needle is put through the skin and muscle into the kidney to remove a small sample of tissue. This is then examined under a microscope to check for signs of cancer. You will need to be observed for about four hours after the biopsy.
Magnetic resonance imaging (MRI) is a type of scan that uses magnetism instead of X-rays to construct a detailed picture of the inside of your body. MRI is used to check the size and extent of a tumour, and to determine whether or not the cancer has spread to other organs of the body. You may be given an injection of special dye or contrast agent into a vein to help the tumours show up more clearly on the MRI scan picture.
Similar to the CT machine, the MRI machine is shaped like a long tube and you lie on a couch, which slides backwards and forwards through the hole. The radiographer watches you on a monitor and can talk to you through an intercom. During the test you have to lie very still on the couch inside the tube for about 30 minutes. It is painless but very noisy and can make people feel a little claustrophobic. If you think you might feel claustrophobic during your scan, please tell the radiographer before your appointment. You should be given earplugs or headphones through which you can listen to music and will be able to hear the radiographer.
You might be asked to have a bone scan to see whether the cancer has spread to your bones. If so, you will be injected with a mildly radioactive material and then asked to wait for a couple of hours while it travels though the blood and collects in the bones. Areas where there is damage to the bone will show up as ‘hot spots’. These aren’t necessarily the result of cancer. If you have arthritis, for instance, this will show up on the scan.
A chest X-ray may be carried out to check your general health and make sure that you are fit enough to have certain treatments or surgery. It will also be used to rule out cancer that has spread to the lungs or chest bones.
You will be asked to go back to hospital for the results of your tests. This may take a little while and you will probably feel worried and upset during this time. Is there anyone you can share your feelings with? Is there a clinical nurse specialist you can talk to? It might be helpful to contact a support group and talk to someone who has been in your shoes. There are some useful numbers listed at www.jameswhalefund.org.
What are my chances?
Being told you have kidney cancer is always a shock. People react in different ways. Some want to find out as much as they can about their treatment and their long-term prospects. Others don’t want to think about the future, preferring to take each day as it comes, without worrying about what may or may not lie ahead.
As doctors know only too well, it can be very difficult to predict what will happen because every patient is an individual. Of course, the earlier your cancer is detected and the sooner treatment begins, the better your chances of long-term survival. Even if your cancer has spread, making it more difficult to treat, it is possible for the symptoms to be kept under control for years. And in some rare cases patients may go into remission for no apparent reason.
There are statistics about average survival rates for people diagnosed with different stages of kidney cancer. You can look at these on www.cancerhelp.org.uk if you choose to. If you do, bear in mind that these are averages and will not tell you how well you will do. Some patients, originally warned that their prospects of survival were poor, have lived for much longer and had a much better quality of life than expected.