SCREENING & DIAGNOSIS
enal cell carcinomas can become quite large without causing
any symptoms. At the present time, there is no specific blood test for
renal cell carcinoma. Patients with a family history (multiple family
members) should be followed more closely. In most cases, renal cell carcinoma
is found when hematuria or blood in the urine is seen. This is the most
common symptom. Many tumors are found incidentally when a procedure or
radiological study is done for vague symptoms. Other signs and symptoms
that may prompt consultation with a doctor include not only hernaturia
but also persistent low back pain, a mass in the abdomen, fatigue, weight
loss, fever not obviously associated with infection and swelling of the
legs. Often these symptoms are associated with other causes that are not
due to cancer but still deserve evaluation. If the tumor is diagnosed
early then the vast majority of patients (80 to 100%) are cured. Incidental
renal cell carcinomas have the most favorable prognosis or outlook.
Diagnosis
-
Physical
Examination - a complete history and physical examination
helps evaluate the entire patient.
- Urinalysis is
performed to microscopically look at the urine to verify there is blood
in it. Sometimes urine cytologies are sent which are used to look for
cancer cells in the urine. Many other blood tests can be done to evaluate
the function of the kidney, liver and other organs.
- There are multiple imaging studies, including intravenous pyelogram
(IVP), ultra-sonography, computerized tomographic (CT) scans, magnetic
resonance imaging (MRI) which can produce images of the kidney.
A CT scan is a modified x-ray procedure which produces
a detailed picture of the inside of the body. MRI uses large magnets
to produce images of the internal organs. Utrasonography uses sound
waves that show the kidney, like one uses sonar to took for a submarine.
Arteriography and angiography are older studies which are still used
that employ contrast dyes to demonstrate blood vessels and image the
kidney. A chest x-ray is used to evaluate the lungs to see if there
is any metastases or spread of cancer. A bone scan uses small amounts
of special radioactive tracer material that can identify cancer in
bones.
- Cystoscopy is
sometimes performed to verify that there are no tumors in the bladder,
and also whether there is bleeding from one or both kidneys.
Staging of Renal
Cell Carcinoma
Staging is a process that demonstrates how far the cancer has spread. The
treatment and prognosis or outlook for RCC will depend significantly on
its stage. There are multiple staging systems but in general stage I cancer
is confined to the kidney, stage II means the cancer has broken through
the kidney capsule and has spread into adjacent tissue, stage III indicates
that it may have spread further into lymph nodes or blood vessels, and stage
IV indicates that it is more wide-spread, particularly in other organs such
as lungs or liver. Other staging definitions vary slightly with stage I
and II being defined on the basis of size. In general, stage I is a small,
confined tumor and stage IV represents wide-spread cancer. |
