Can kidney cancer be found early?

Although many kidney cancers are found fairly early, while they are still confined to the kidney, others are found at a more advanced stage. There are a few reasons for this:

• These cancers can sometimes become quite large without causing any pain or other problems.
• Because the kidneys are deep inside the body, small kidney tumors cannot be seen or felt during a physical exam.
• There are no recommended screening tests for kidney cancer in people who are not at increased risk.

A routine urine test (urinalysis), which is sometimes part of a complete medical checkup, may find small amounts of blood in the urine of some people with early renal cell cancer. But this test is not a good way to look for kidney cancer. Many things other than kidney cancer cause blood in the urine, including urinary tract infections, bladder infections, bladder cancer, and benign (non-cancerous) kidney conditions such as kidney stones. Also, some people with kidney cancer do not have blood in their urine until the cancer is quite large and might have spread to other parts of the body.

Imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans can find small renal cell carcinomas. But these tests are expensive and cannot always tell benign tumors from small renal cell carcinomas.

For these reasons, doctors generally recommend CT and MRI for early detection of kidney cancer only in people who have inherited conditions that raise their risk of kidney cancer, such as von Hippel-Lindau disease. Some doctors also recommend that people with kidney diseases treated by long-term dialysis have periodic tests (CT or MRI scans) to look for kidney cancer.

Ultrasound is less expensive and may also detect early kidney cancer. However, to recommend screening tests for people without risk factors or symptoms of a cancer, studies have to show the test improves survival. No imaging tests screening for kidney cancer have done this.

Often, kidney cancers are found incidentally (by accident) during tests for some other illness such as gallbladder disease. These cancers usually are causing no pain or discomfort when they are discovered. The survival rate for kidney cancer found this way is very high because these cancers are usually found at a very early stage.

Genetic tests for inherited conditions linked to kidney cancer

It is important to tell your doctor if family members (blood relatives) have or had kidney cancer, especially at a younger age, or if they have been diagnosed with an inherited condition linked to this cancer, such as von Hippel-Lindau disease. Your doctor may recommend that you consider genetic testing. Only people who have clinical signs of these conditions or blood relatives with these clinical signs are genetically tested for these conditions.

Before having genetic tests, it's important to talk with a genetic counselor so that you understand what the tests can − and can't − tell you, and what any results would mean. Genetic tests look for the gene mutations that cause these conditions in your DNA. They are used to diagnose these inherited conditions, not kidney cancer itself. Your risk may be increased if you have one of these conditions, but it does not mean that you have (or definitely will get) kidney cancer. For more information on genetic testing, see the separate document, Genetic Testing: What You Need to Know.

If you have been diagnosed with one of these conditions, you might need frequent CT or MRI scans to look for early kidney cancer.