Most kidney tumours are found incidentally — during an evaluation with radiologic imaging studies for other nonspecific abdominal complaints (gallbladder pain, for example), or during follow-up for other previously treated malignancies. These “incidental cancers” are often found early, before any symptoms have occurred. Because such cancers are usually detected before they have spread, patients with incidental kidney tumours are often cured of their disease, commonly by surgery alone.
Moreover, as many as 30 percent of kidney masses represent a benign condition.
If Dr Ruban suspects you have a kidney tumour, he may recommend computed tomography (CT) scanning or magnetic resonance imaging (MRI). Recently developed imaging techniques — including 3-D CT, 3-D MRI angiography (imaging of the blood vessels), and CT urography (imaging of part of the urinary tract) — reveal detailed anatomy, which allows surgery to be planned, often using a single imaging test. Ultrasound may be used when it is necessary to determine whether a kidney mass is a fluid-filled cyst or a solid tumor. To limit the radiation exposure to our patients as much as possible, we make every attempt to perform CT scans only when absolutely necessary.
If Dr Ruban suspects that you have cancer of the renal pelvis, or transitional cell carcinoma, he may perform one of the following:
- Cytoscopy, which involves inserting a small tube with a lens into the urethra to allow the bladder and urethra to be seen;
- Pyelogram, which involves taking an X-ray of the kidneys and ureters.
Ureteroscopy, which involves passing a narrow lighted tube through the urethra, into the bladder, into a ureter, and into the renal pelvis to look for signs of cancer.
Dr Ruban may remove a small piece of tissue (a biopsy) to examine it for cancer cells.
After surgery to remove a renal cortical tumour, the tumour cells will be examined to determine if the tumor is benign or malignant. If it is cancerous, the cell type will be determined. This information will then be used, along with the size of the tumour and other aspects of the tumour’s growth, to more accurately predict the prognosis and determine whether further treatment is necessary.
In addition to these tests, when making treatment decisions your full medical history will be taken into account, a physical examination will be performed, and blood and urine tests may be ordered.