Initial Evaluation

As stated above, the first step in evaluation is a CT scan or MRI with contrast.  Depending on the initial imaging, the kidney cancer expert will consider you as having either:

  • Early-stage, clinically-localized renal mass: usually a "small" tumor that appears confined to the kidney.  These masses have a likelihood of either being a benign tumor, OR, if a cancer, has a high likelihood of being cured.
  • Locally advanced kidney cancer: a cancer that is growing from the kidney into structures around the kidney, usually lymph nodes or blood vessels. 
  • Metastatic kidney cancer: a cancer that has spread from the kidney to other organs like the lung, brain or bones.

The next steps in evaluation are related to the expert's summation of your kidney mass and may include additional imaging of the chest, abdomen, and pelvis and comprehensive blood work.  Bone scans and evaluations of the brain are obtained depending on symptoms and the results of the initial studies.  PET scans are rarely useful for detecting kidney cancer.

Should I get a biopsy?
Renal mass biopsy has improved over the past several years and can be useful in certain circumstances.  Renal mass biopsy can often distinguish benign from malignant tumors and the risks associated with renal mass biopsy are low – there is a small risk of bleeding and pain associated with the procedure.  In fact, the risk of spreading the cancer with a needle is almost non-existent with modern techniques. 

However, due to a number of circumstances the non-diagnostic rate for biopsy ranges from 10-20%.  And due to the nature of renal cancers it is challenging to tell aggressive cancers from indolent, or benign behaving, cancers.  Your kidney cancer expert will discuss the pluses and minuses of renal mass biopsy in your circumstance and decide, with you, if you should undergo a biopsy.