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Fact sheet Diagnosis and types of Cancer

Introduction

Our series of fact For more information relating These fact sheets are meant as an sheets have been developed to help to other aspects of kidney cancer introduction only and are not meant you understand more about kidney please see our other fact sheets: to be a substitute for your doctor’s cancer. This fact sheet provides • Kidney Cancer or healthcare professional’s advice. information about the tests you may • Localised Kidney Cancer Always consult your doctor or have if your doctor thinks you may • Advanced Kidney Cancer healthcare professional for have kidney cancer. It also gives more advice. • Support for Kidney Cancer information about the different types and stages of kidney cancer. • Advanced Kidney Cancer – Dealing with the side effects of medication: targeted therapy • Kidney Cancer – Make the most of your visit to the doctor

What tests will I need to have?

Your doctor will use different tests to diagnose and get more information about your kidney cancer. The tests done for kidney cancer can be divided into blood and urine tests, imaging, tissue biopsy and cystoscopy. 1. Blood and urine tests The tests you have will depend Blood tests: Chemical tests of the on your particular situation. blood can detect findings associated You may not necessarily need to with kidney cancer. have all the tests described below. Urine test (urinalysis): A common sign of a kidney cancer is blood in the urine. Remember that blood in the urine can be caused by conditions other than cancer as well. This test can also detect other abnormalities in the urine such as protein.

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MRI scan PET scan An MRI scan uses a combination A positron emission tomography of magnetism and radio waves to (PET) scan is a specialised scan get detailed pictures of organs in the that uses radioactivity to show the body. They provide different details to chemical function of an organ or a CT scan and give information about: tissue. It can detect cancers even 2. Imaging • Whether the tumour has before they are ‘seen’ on other types Imaging is important for the diagnosis spread into the veins of scans. PET scans can create an and classification of kidney cancer. • Whether the tumour has image of the entire body. This means The most common imaging techniques spread into the spinal cord. that they can show if (and where) used are ultrasound scans, computed cancer is spreading to other parts tomography (CT) scans and magnetic of the body. PET scans can also be resonance imaging (MRI) scans. You • An MRI takes about used to see if tumours, are benign may have more than one type of scan. 40–60 minutes (not cancer) or malignant (cancer) and to tell the difference between • The MRI scanner is a large tumour or scar tissue. Ultrasound magnetic metal cylinder open A type of scan where sound waves at both ends. You lie still on are used to produce a picture of the a table inside the cylinder internal organs on a computer screen. • A PET scan takes about 2 hours • You may be given contrast Any abnormalities in the kidney and • You may need to not eat or other organs can be seen on the screen. • It is painless. However, the drink before the scan scanner can be noisy and • You will be given an injection some people feel anxious of radioactive material about being in a small space. • An ultrasound takes about • The amount of radiation 15–20 minutes Talk to you doctor if you think this may be a problem for you. you receive is small • A gel is spread over your back • It is painless. or side and an ultrasound probe is slid over the skin Bone scan • It is painless. Chest x-ray A bone scan is used to see if An x-ray of organs and bones cancer has spread to the bones. within the chest: CT scan A CT scan uses x-rays to get detailed • A bone scan takes about 5 hours pictures of organs in the body. They • A chest X-ray takes • A small and harmless amount provide information about: a few minutes of radioactive material is • Where the tumour is located • It is painless. in the kidney and its size injected into a vein • Whether a tumour looks like • The substance slowly moves through your blood into your it maybe cancer (malignant) Contrast bones. It particularly goes into or not cancer (benign) Most CT and MRI scans are done the cancer cells • Whether there are enlarged with contrast (a kind of dye). Contrast lymph nodes or not • After 3–4 hours a scan is done is administered through a drip line that detects radioactivity. If the • Whether the tumour has in one of your veins (intravenous cancer has spread to the bones spread to other parts of line), usually your arm. The contrast it will show up as a large the body (metastasised). highlights the arteries and veins, amount of radioactivity giving more information about the • It is painless. tumour. It may make you feel hot • A CT scan takes about and flushed for a few minutes. Some 30–40 minutes people are allergic to contrast so let the person doing the scan • The CT scanner is like a large know if you feel unwell. round metal doughnut. You lie still on a table that goes through the hole of the scanner • You may be given contrast • It is painless.

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In the majority of cases of kidney cancer a biopsy is not necessary. • A kidney biopsy takes about This is because the CT or MRI scan an hour and is done as has already given enough information an outpatient for your doctor to recommend surgery • Local anaesthetic is given or other treatments for your kidney to numb the area cancer. However, a biopsy may be 3. Kidney (renal) biopsy • The biopsy is taken whilst recommended if: Sometimes your doctor will a scan is being done so • The results of your scan suggest recommend that you have a kidney the tumour can be found that the tumour is benign biopsy. A kidney biopsy is where • A fine needle is used to get one samples of tissue are taken from • The tumour is small and can be or two samples of the tumour treated with active surveillance, the tumour so that the cells can • Biopsies may cause a small radiotherapy ablation or cryotherapy then be examined under a amount of blood in the urine, (see later in the treatment section). microscope. This gives the doctors which is normal. more information about what sort • You will have to lie flat for of is present. 4 hours after the biopsy • Then you should expect to take it easy for the rest of the day • Rarely a biopsy can cause more severe bleeding and if this happens when you are home you should go straight back to the hospital.

• A cystoscopy takes about an hour and is done as an outpatient (you will not need to stay overnight in the hospital) 4. Cystoscopy • You will be given either a If you have blood in your urine you local or general anaesthetic may have a cystoscopy. This is a test • A telescope is passed into your that lets your doctor look into your bladder through the urethra bladder and urethra using a telescope with a lens and a light. It is used to see • You should take it easy for if the blood in your urine is coming the rest of the day from your bladder or urethra. • You may feel a burning sensation when having a wee or notice blood in your urine. This is normal but let your doctor know if it lasts more than a few days.

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What are the different types of kidney cancer?

Not all kidney cancers are the same. 1. The exact subtype of kidney This information can be used by your The results of the tests you have cancer – how the cancer cells doctor to guide treatment and help had give information about: look under a microscope and other plan long-term follow-up care. features. Different subtypes come from different cells in the kidney. 2. The grade of kidney cancer – how abnormal the cells are and how fast they’ll probably grow. 3. The stage of kidney cancer – how large the cancer is and how far it has spread.

1. Different subtypes of kidney cancer (RCC) Urothelial carcinoma There are different types of kidney cancer based on what the cancer • 9 out of 10 kidney cancers • 1 out of 10 kidney cancers cells look like under a microscope and other factors. Renal cell carcinoma • Comes from the cells of • Comes from the cells of the (RCC) is the most common type of the kidney’s nephrons drainage system of the kidney kidney cancer and the second most (the renal pelvis or ureters) common type is urothelial carcinoma. This series of fact sheets mainly gives Subtypes: • Behaves like and information about RCC. • Clear cell – about 75 out so is treated differently to RCC of 100 RCC are this type • Also known as transitional cell The type of kidney cancer is not • Papillary cell – about 10 out carcinoma (TCC) usually important for surgery, but of 100 RCC are this type it can be very important if more treatment is needed. If more • Chromophobe – about 5 out treatment is needed, knowing the of 100 RCC are this type type of kidney cancer helps your • Others doctor to talk with you about the best treatment options.

2. The grades of kidney cancer Kidney cancer can also be described as aggressive (quickly growing) or non-aggressive (slowly growing).

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3. Stage of kidney cancer Stage of kidney cancer: TNM staging system What is a staging system for kidney cancer? T (tumour) 1-4 Indicates the size of the primary kidney tumour A staging system is a standard way for and whether it has spread into nearby areas. your healthcare team to describe how A higher number of T means that the tumour is large the cancer is and how far it has larger, or has spread to areas around the kidney. spread. There are a number of ways to Tx Indicates the tumour cannot be assessed. stage kidney cancer. The most common one is known as the TNM system. N (nodes) 0-1 Indicates whether the cancer has spread to nearby lymph nodes (part of the immune What are the stages of system). 0 means the cancer has not spread, kidney cancer? 1 means the cancer has spread. Once the T, N, and M scores are Nx Indicates lymph nodes can not be assessed. known they can be used to give the kidney cancer overall stage of I, II, III, or IV. Each different stage groups M (metastasis) 0-1 Indicates whether the cancer has spread cancers together that have a similar (metastasised) to distant parts of the body. 0 means the cancer has not spread; outcome (prognosis) and are treated 1 means the cancer has spread. in a similar way.

Stage I Stage II Stage III Stage IV

STAGE Localised Localised Locally advanced Advanced

Less than 7cm Larger than 7cm Any size Any size SIZE

Only in the kidney Only in the kidney Spread to local lymph Spread beyond the nodes, blood vessels kidney – metastasised and tissues LOCATION

If the cancer can be If the cancer can be The chance of being Unlikely to be cured removed, surgery is removed, surgery is cured by surgery is lower but various treatment a good treatment option a good treatment option but not zero; medication options can slow growth

TREATMENT may be used SURVIVAL

Survival decreases as stage increases

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A note on 5 year survival rates 5 year survival rates only give a Survival from kidney cancer has Survival rates are often used by general idea, they cannot predict improved. In the 1980s, only 45 out doctors as a way of discussing how what will happen in any individual of every 100 people with kidney long a person will live after a diagnosis person’s case. Many things can affect cancer survived at least five years. of cancer – their prognosis. The 5 year a person’s prognosis, such as the grade Now about 73 out of every 100 people survival rate refers to the percentage of the cancer, the treatment received, with kidney cancer survive at least of patients who live at least 5 years age and overall health. If you want to 5 years. This improvement in survival after their cancer is diagnosed. Of know your prognosis, your doctor can from kidney cancer is due to kidney course, many people live much longer give you a general idea. cancer being diagnosed earlier and than 5 years, many are cured, and better treatments. some people die from causes other than their cancer.

Who can I contact for more support & information?

Both Kidney Health Australia and Kidney Health Australia Cancer Cancer Council offers reliable the Cancer Council offer a free and Support & Information Service cancer information and support to confidential service for further Kidney Health Australia provides anyone affected by cancer, including support and information. support and information for kidney patients, carers, families, friends, and cancer patients, their families and healthcare professionals. They can carers in a variety of different ways. connect you with others who have been through a similar experience Free call: 1800 454 363 and link you to practical, emotional [email protected] and financial support in your area. kidneycancer.org.au forum.kidney.org.au Free call: 13 11 20 cancer.org.au

This is intended as a general For more information introduction to this topic and is not about kidney or urinary meant to substitute for your doctor’s If you have a hearing or healthcare professional’s advice. or speech impairment, All care is taken to ensure that health, please contact the information is relevant to contact the National the reader and applicable to each Relay Service on our free call Kidney Health state in Australia. It should be noted that Kidney Health Australia 1800 555 677 or Information Service recognises that each person’s relayservice.com.au experience is individual and that (KHIS) on 1800 454 363. variations do occur in treatment For all types of services and management due to personal ask for 1800 454 363 Or visit our website circumstances, the healthcare professional and the state one kidney.org.au to access lives in. Should you require further information always consult your free health literature. doctor or healthcare professional.

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What does that word mean?

Anaesthetic – A drug that stops Cystoscopy – A test using a special Positron emission tomography scan a person feeling pain during a telescope to look into the bladder. (PET) – A scan using radioactivity to medical procedure. A general produce detailed pictures of the body. anaesthetic affects the whole of Grade – A description of a tumour your body by making you temporarily based on how abnormal the cancer Prognosis – The likely outcome or unconscious. A local anaesthetic cells look under a microscope and course of a disease, the chance of affects only part of your body by how quickly it is likely to grow and recovery or recurrence. making that area numb. spread. Stage – The extent of the cancer Biopsy – Removal of a small sample Grading – A score that is used to in the body (how large it is, whether of tissue from the body to be describe how quickly a tumour is likely it has spread to lymph nodes, and examined under the microscope to grow and how likely it is to spread. whether the cancer has spread to help diagnose a disease. to other parts of the body). Intravenous line (iv line) – A small Bone scan – A scan using small plastic tube inserted into a vein Staging – Performing physical amounts of radioactive material to see (blood vessel) using a needle. Once examinations and diagnostic tests if the cancer has spread to the bones. in place, the needle is removed. It is to determine the extent of the cancer used to give fluids and medications. in the body (the stage). Computed tomography scan (CT) – A scan using X-rays to produce Magnetic resonance imaging scan Ultrasound – A scan that uses detailed pictures of the body. (MRI) - A scan using magnetic and soundwaves to generate a picture radio waves to produce detailed of parts of the body. Contrast medium/agent/dye – pictures of the body. A substance injected into a vein Urinanalysis – A test of the urine. before a scan that gives more information about the tumour.

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