If you’re experiencing symptoms such as blood in your urine, lower back pain, weight loss, or a lump on your side, see your doctor.

These could be signs of renal cell carcinoma, which is cancer of the kidneys. Your doctor will run tests to find out whether you have this cancer and, if so, whether it has spread.

To start, your doctor will ask questions about your medical history. You might also be asked about your family’s medical history to see if you have any risk factors for renal cell carcinoma.

Your doctor will ask about your symptoms and when they started. And, you’ll likely get a physical exam so your doctor can look for any lumps or other visible signs of cancer.

If your doctor suspects RCC, you’ll have one or more of these tests:

Lab tests

Blood and urine tests don’t definitively diagnose cancer. They can find clues that you might have renal cell carcinoma or determine whether another condition, such as a urinary tract infection, is causing your symptoms.

Lab tests for RCC include:

  • Urinalysis. A sample of your urine is sent to a lab to look for substances like protein, red blood cells, and white blood cells that can show up in the urine of people with cancer. For example, blood in the urine can be a sign of kidney cancer.
  • Complete blood count (CBC). This test checks levels of red blood cells, white blood cells, and platelets in your blood. People with kidney cancer may have too few red blood cells, which is called anemia.
  • Blood chemistry tests. These tests check levels of substances like calcium and liver enzymes in the blood, which kidney cancer can affect.

Imaging tests

Ultrasound, CT scan, and other imaging tests create pictures of your kidneys so your doctor can see whether you have cancer and if it has spread. Imaging tests that doctors use to diagnose renal cell carcinoma include:

  • Computed tomography (CT) scan. A CT scan uses X-rays to create detailed pictures of your kidneys from different angles. It’s one of the most effective tests for finding renal cell carcinoma. A CT scan can show the size and shape of a tumor and whether it has spread from the kidney to nearby lymph nodes or other organs. You might get a contrast dye injected into a vein before the CT scan. The dye helps your kidney show up more clearly on the scan.
  • Magnetic resonance imaging (MRI). This test uses powerful magnetic waves to create images of your kidney. Although it’s not as good for diagnosing renal cell cancer as a CT scan, your doctor might give you this test if you can’t tolerate the contrast dye. An MRI can also highlight blood vessels better than a CT scan, so it might be useful if your doctor thinks the cancer has grown into blood vessels in your belly.
  • Ultrasound. This test uses sound waves to create pictures of the kidneys. An ultrasound can tell if a growth in your kidney is solid or filled with fluid. Tumors are solid.
  • Intravenous pyelogram (IVP). An IVP uses a special dye injected into a vein. As the dye moves through your kidneys, ureters, and bladder, a special machine takes pictures of these organs to see if there are any growths inside.

Biopsy

This test removes a sample of tissue from potential cancer with a needle. The piece of tissue is sent to a lab and tested to find out if it does contain cancer.

Biopsies aren’t done as often for kidney cancer as they are for other types of cancer because the diagnosis is often confirmed when surgery is done to remove the tumor.

Staging RCC

Once your doctor has diagnosed you with RCC, the next step is to assign a stage to it. Stages describe how advanced the cancer is. The stage is based on:

  • how large the tumor is
  • how aggressive it is
  • whether it has spread
  • which lymph nodes and organs it has spread to

Some of the same tests used to diagnose renal cell cancer also stage it, including CT scan and MRI. A chest X-ray or bone scan can determine if the cancer has spread to your lungs or bones.

Renal cell carcinoma cancer has four stages:

  • Stage 1 renal cell carcinoma is smaller than 7 centimeters (3 inches), and it hasn’t spread outside of your kidney.
  • Stage 2 renal cell carcinoma is larger than 7 cm. It’s only in the kidney, or it has grown into a major vein or tissue around the kidney.
  • Stage 3 renal cell carcinoma has spread to lymph nodes close to the kidney, but it hasn’t reached distant lymph nodes or organs.
  • Stage 4 renal cell carcinoma may have spread to distant lymph nodes and/or other organs.

Knowing the stage can help your doctor determine the best treatment for your cancer. The stage can also give clues about your outlook, or prognosis.