Metastatic Renal Cell Carcinoma

How is the presence of renal cell carcinoma detected?

Cancer staging, along with results of other physiological tests, helps physician in assessing the spread of tumour and in devising a suitable treatment plan.

Several tests employed by the doctor will tell whether the renal cell carcinoma (RCC) is present and if present, how far it would have spread (metastasized). Recommended tests for kidney cancer screening are however not available at present. For a person with higher propensity of developing RCC, doctor may advice for a CT scan or renal ultrasound test.

Diagnostic tests are chosen depending on signs & symptoms, general health and medical history of the patient. This is done with one or a combination of the following tests:

I. Blood and Urine tests

These tests may not give a definite diagnosis, but can be indicative of a disease condition.

II. Biopsy

During biopsy, a small amount of surgically removed tissue in examined under the microscope for the type of cell involved in cancer. The resultant helps the doctor in planning treatment.

III. Imaging tests

• X-ray
• Computed tomography (CT/CAT) scan: A CT scan allows 3-dimensional reconstruction of the part that is imaged. If tumour is present, this helps in measuring the tumour size as well. A special dye (that gives better detail on the images) may be injected into the body during this process.
• Magnetic resonance Imaging (MRI): MRI uses magnetic field to produce detailed images
• Intravenous pyelogram (IVP): A rarely used test, where is dye injected into the bloodstream that highlights kidney, urethra and bladder, which later aids in in-depth imaging.

Is it possible to know how far it has spread? How?

To understand and assess the spread of tumour is called ‘staging’. Once a specific stage has been identified, the doctor uses this understanding to devise the best possible treatment plan. Kidney cancer is staged using the TNM (Tumour-Node-Metastasis) system. The three main determinants of the TNM system are Tumour (what is the size of the tumour?), Node (Has the cancer spread to nearby lymph nodes?) and Metastasis (Has the cancer spread to distant organs of the body?). The TNM information is then used to determine the pathologic ‘stage’ of the cancer (Figure 2).

Figure 2: Staging of kidney cancer
Source : Herbert T. Cohen, Francis J. McGovern. (2005). Renal cell carcinoma. NEJM, 353, 2477

Figure 2: Staging of kidney cancer
Source : Herbert T. Cohen, Francis J. McGovern. (2005). Renal cell carcinoma. NEJM, 353, 2477