How is kidney cancer diagnosed and assessed?
To confirm the diagnosis
An ultrasound scan of the kidney can usually detect a kidney cancer. This is often one of the first tests done if your doctor suspects that you may have kidney cancer. (An ultrasound scan is a safe and painless test which uses sound waves to create images of organs and structures inside your body. See separate leaflet for more details of this test.)
Intravenous urography is a special x-ray test which is sometimes used to detect a kidney cancer. The urinary tract does not show up well on ordinary x-ray pictures. However, with intravenous urography a contrast dye is injected into a vein ('intravenous' injection). The dye travels in the bloodstream, concentrates in the kidneys, and is passed out into the ureters with urine made by the kidneys. The dye blocks x-rays so the structure of the kidneys, ureters and bladder shows up clearly as white on x-ray pictures. (See separate leaflet for more details of this test.)医学全在线www.med126.com
Assessing the extent and spread
If you are found to have a kidney cancer then further tests may be advised to assess if the cancer has spread. For example, a CT scan, an MRI scan, a chest x-ray, blood tests, or other tests. (There are separate leaflets which describe each of these tests in more detail.) This assessment is called 'staging' of the cancer. The aim of staging is to find out:
Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis). See separate leaflet called 'Cancer Staging and Grading' for details.
What are the treatment options for kidney cancer (renal cell cancer)?
Treatment options which may be considered include surgery, radiotherapy, arterial embolisation and immunotherapy. (In general, chemotherapy does not work as well for kidney cancer as for some other types of cancer. Therefore it is not often used as a treatment.) The treatment advised for each case depends on various factors such as the stage of the cancer (how large the cancer is and whether it has spread), the exact sub-type or 'grade' of the cancer, and your general health.
You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer.
You should also discuss with your specialist the aims of treatment. For example:
Surgery
An operation to remove all (or sometimes part) of the affected kidney is the most common treatment. If the cancer is at an early stage and not spread then surgery alone may be curative. If the cancer has spread to other parts of the body, surgery to remove the affected kidney may still be advised, often in addition to other treatments.
In some cases, surgery is done to remove a secondary kidney tumour which has spread to another part of the body. For example, some secondary tumours which develop in the liver or lung can be removed.
Radiotherapy
Radiotherapy is a treatment which uses high energy beams of radiation which are focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (There is a separate leaflet which gives more details about radiotherapy.) Radiotherapy may be advised in addition to surgery which aims to kill any cancerous cells which may have been left behind following an operation. It may be used to treat the primary cancer instead of surgery if your general health is poor. Radiotherapy is also commonly used to treat kidney cancer which has spread to other sites such as secondary tumours which develop in a bone or the brain.
Arterial embolisation
This may be used instead of surgery (for example, if you are not well enough for surgery). The aim of this treatment is to block off the blood vessel (artery) which is supplying a kidney tumour with blood. To do this a catheter is inserted into a blood vessel in the groin. (A catheter is a long thin, flexible, hollow tube. ) Using x-ray pictures for guidance, the catheter is pushed up into the blood vessel in the affected kidney. When it is in the right place a substance is injected down the catheter into the blood vessel to block the blood vessel. The tumour is then deprived of it's blood supply and so dies.
Immunotherapy (sometimes called biological therapy)
This treatment uses drugs to stimulate the immune system to attack cancerous cells. Two drugs are commonly used to treat kidney cancer - interferon and aldesleukin (sometimes called interleukin 2).
Other immune therapies such as using 'vaccines' to stimulate your immune system to fight cancer cells and using monoclonal antibodies to attack cancer cells are being investigated as possible new treatments for kidney cancer.
What is the prognosis (outlook)?
The outlook is best in those who are diagnosed when the cancer is confined within a kidney, has not spread, and who are otherwise in general good health. Surgical removal of an affected kidney in this situation gives a good chance of cure. However, many people with kidney cancer are diagnosed when the cancer has already spread. In this situation a cure is less likely. However, treatment can often slow down the progression of the cancer.
The response to treatment can also vary from case to case. This may be partly related to the exact sub-type or grade of the cancer. Some kidney cancers, even some which are advanced and have has spread, respond much better to immunotherapy than others.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.
