How is kidney cancer diagnosed?

A number of tests may be performed to investigate symptoms of kidney cancer and confirm a diagnosis. Some of the more common tests include: 

• physical examination 
• urine testing (urinalysis), using chemical tests and examination of urine under a microscope 
• blood tests 
• imaging of the kidneys, which may include CT, MRI, ultrasound scans or intravenous pyelogram (involving X-rays of the kidneys, ureters and bladder). 

Removal of a small sample of tissue (biopsy) for examination under a microscope or laboratory testing is not usually needed to diagnose kidney tumours, but it may be used if there is some uncertainty about the diagnosis. 

Stages of kidney cancer 

If you are diagnosed with kidney cancer, you might have more tests to determine the stage of the disease and whether the cancer has spread to other parts of the body. Knowing the stage of the disease helps your medical team plan the best treatment for you. 

Kidney cancer (renal cell cancers) is divided into 4 stages, based on the size of the main tumour, the extent to which the cancer has spread to nearby lymph nodes, and whether the cancer has spread (metastasised) to other parts of the body, such as the lungs, bones, liver, brain and distant lymph nodes: 

• Stage I – 
  • the tumour is 7 cm across or smaller and is only in the kidney. 
• Stage II –
  • ​ the tumour is larger than 7 cm across but is still only in the kidney. 
• Stage III – 
  • the tumour is growing into a major vein or into tissue around the kidney, but is not growing into the adrenal gland or beyond the fibrous layer that surrounds the kidney, and has not spread to lymph nodes or distant organs; OR 
  • the tumour has spread to nearby lymph nodes but has not spread beyond the fibrous layer that surrounds the kidney, or to distant lymph nodes or other organs. 
• Stage IV –
  • the tumour is growing beyond the fibrous layer that surrounds the kidney, and may be growing into the adrenal gland on top of the kidney or in nearby lymph nodes; it has not spread to distant lymph nodes or other organs; OR 
  • the tumour has spread to distant lymph nodes, or other organs, or both.