Kidney cancer often doesn’t cause noticeable symptoms. About 50 percent of cases are found during routine testing or imaging, such as a CT scan or an X-ray, done for another reason. In some cases, doctors order tests because they suspect kidney cancer.

No matter how kidney cancer is first found, you’ll have more tests to figure out if a tumor is cancerous, what type of kidney cancer it is, and its size and stage. Your oncologist will decide which tests are right for you.

In this article, tests are listed in the order they may happen, but each doctor may use a different process.

🗳️ Which imaging scans did you have when you were diagnosed with kidney cancer?

Ultrasound

MRI

PET

Multiple types of imaging scans

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Physical Exam

During a physical exam, a doctor or nurse will assess your overall health. This will be a lot like a routine physical exam. They may listen to your heart, check your blood pressure, take your pulse, and weigh you. They’re also likely to ask you about your personal medical history and your family medical history, including whether you have family members with kidney cancer.

If you have symptoms that make your doctor think you may have kidney cancer, they might feel your abdomen for anything unusual. They may also check for swollen lymph nodes.

Your kidneys sit deep inside your body, so a doctor may not feel anything unusual, even if a tumor is there. That is why they rely on other tools and tests to get a better look.

Blood Tests

Blood tests don’t diagnose kidney cancer, but they can give your doctor other important information. They can rule out other conditions that might be causing symptoms, check on your general health, and test how well your kidneys are working. Your doctor may order a complete blood count, which checks for healthy levels of each kind of cell in your blood.

If your doctor thinks you may have kidney cancer or another kidney problem, they may order kidney function tests like estimated glomerular filtration rate and urine albumin-creatinine ratio. These tests tell the doctor how well your kidneys are working. Abnormal results might mean that more testing is needed.

Urine Tests

Urine tests are done for many of the same reasons as blood tests. Here is what doctors look for:

• Hematuria — About 40 percent of people with kidney cancer test positive for hematuria (blood in their urine), although you may not be able to see the blood.
• Protein levels — If a doctor finds a protein called albumin in your urine, it may be a sign that your kidneys aren’t filtering blood as well as they should.
• Cytology — This test checks urine under a microscope to look for cancer cells, especially if doctors think there may be cancer in the urinary tract.

They may also want to test for an infection, which can affect how well your kidneys work.

Imaging Tests

Imaging tests are often used to find kidney tumors, see how big they are and where they are, and help guide treatment. Different doctors may prefer different tests, though some are more common than others. Imaging tests are a key part of diagnosing kidney cancer.

Ultrasound

An ultrasound uses sound waves to create images inside your body. A radiologist moves a small tool called a probe over your skin to take the images.

Your general doctor might order an ultrasound to help decide whether to send you on to a specialist. The specialist may order another ultrasound if they want updated or different pictures of your kidneys.

An ultrasound can show signs of a kidney tumor. It can also give details about the tumor, such as whether it’s more likely cancerous or benign (not cancerous).

Benign tumors are less likely to grow and cause problems, so they may need different treatment than cancerous tumors. An ultrasound can also show if a tumor or another problem is blocking the tubes between your kidneys and bladder.

CT Scan

CT scans use X-rays to produce pictures of the inside of your body. You’ll lie still on a table that will slide into the scanner, although you may be asked to move or change position during the scan.

Your doctor may order a CT scan with contrast, which means you’ll have to drink a liquid or get dye through an IV line.

The dye helps the doctor see any tumors more clearly. A CT scan of the abdomen gives information about whether you have tumors in your kidneys, how big they are, and whether they’ve spread.

MRI

Your doctor may order an MRI for kidney cancer if you can’t have the dye they use for many CT scans. MRI may also be used if they’re looking for signs of cancer in the blood vessels near the kidneys or to see whether cancer has spread.

To have an MRI scan, you’ll need to remove metal jewelry and tell your doctor if you have any metal or medical devices in your body, such as a hip or knee replacement. You’ll need to lie inside an enclosed space between 15 and 90 minutes.

MRIs don’t hurt, but they’re loud. You can usually bring earplugs or headphones. If you’re afraid of being in enclosed spaces, you can ask for medication to help you relax.

Intravenous Pyelogram or Angiography

These tests are similar to a CT scan. They use X-rays and contrast dye to look at your kidneys, nearby blood vessels, bladder, and ureters, which are the tubes between your kidneys and bladder. They may be done as part of a CT scan or an MRI. These tests give your doctors detailed images that may help them diagnose kidney cancer and plan treatment.

Cystoscopy or Ureteroscopy

These tests use a thin tube with a small camera and light to look inside parts of the urinary tract, such as the bladder, urethra, and ureter. They can help doctors see whether a tumor is affecting those areas.

Bone Scan, Chest X-Ray, and Positron Emission Tomography Scan

These imaging tests are done to see whether kidney cancer cells have spread to other parts of the body. In a bone scan, your doctor injects a small amount of radioactive material, then uses a scanner to look closely at your bones.

A chest X-ray takes pictures of your chest. You may need more tests if the X-ray shows anything unusual.

Positron emission tomography (PET) scans use a small amount of radioactive material to show areas where cells are more active than usual. You’ll be injected with the tracer, then have the scan. A PET scan can sometimes help show whether cancer has spread, but it isn’t used for every person with kidney cancer.

Kidney Biopsy

A kidney biopsy involves taking a tiny sample of your kidney and tumor with a needle. A doctor will usually numb your skin, then insert the needle. They may use ultrasound or X-ray technology to guide the needle so they can be sure to get the sample they need.

You may not need a biopsy to diagnose kidney cancer. Your oncology team may recommend a biopsy if they need more information about the tumor, need to confirm that it’s cancer, or need to plan treatment when surgery isn’t an option.

After the biopsy, the sample is sent to a lab. A pathologist looks at it under a microscope and may run more tests.

What To Expect

Kidney cancer testing can include several steps, from a physical exam and blood or urine tests to imaging scans or a biopsy. Your healthcare team can explain why each test is needed, what the results mean, and what steps may come next.

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On MyKidneyCancerTeam, people share their experiences with kidney cancer, get advice, and find support from others who understand.

What tests and scans have you had for kidney cancer? Let others know in the comments below.