Diagnosis and Staging

Early, accurate diagnosis and staging of kidney cancer is critical to delivering the most effective treatments and achieving optimal patient outcomes. Better tests are helping us diagnose kidney cancer earlier and leading to better outcomes for patients.

Diagnosis

A patient’s symptoms – along with a medical history, physical exam, urinalysis, blood work, or imaging for another reason – can suggest kidney cancer.

UT Southwestern’s experienced physicians diagnose the disease using advanced imaging techniques that include:

Our specialists are also improving methods of noninvasively diagnosing and monitoring tumors through advanced MRI approaches.

Types of Kidney Cancer

There are several types of kidney cancer.

  • Renal cell carcinomas (RCCs) comprise about 90 percent of kidney cancer cases, with clear cell renal cell carcinoma making up approximately 70 percent of those.
    • Clear cell renal cell carcinomas (ccRCCs) can be further subdivided according to their molecular genetics into several subtypes. Investigators at UTSW discovered that the BAP1 gene is mutated in 15% of ccRCC and that mutations in BAP1 tend to be mutually exclusive with mutations in PBRM1 (Pena-Llopis et al., Nat Genet 2012). These findings led to the discovery that ccRCC can be classified into 4 subtypes: not mutated, mutated for PBRM1, mutated for BAP1, and a small group of tumors that are mutated for both genes. This classification is important, as these different subtypes are associated with markedly different outcomes.
    • To study the different subtypes of ccRCC, UTSW investigators have genetically engineered mice with the same mutations found in patients. Their study was the first to report the successful generation of a mouse reproducing the genetic events found in human kidney cancer (Wang et al., PNAS 2014). Press Release
  • Papillary and chromophobe renal cell carcinomas – along with a handful of very rare RCC subtypes – account for the remaining 30 percent of RCC cases.
    • UTSW investigators were the first to perform integrated genomic analyses on non-clear cell RCC, including papillary, chromophobe, and translocation carcinomas (Durinck et al., Nat Genet 2015). These discoveries laid the foundation for a classification of these tumors that is based on genetics rather than solely based on their appearance under the microscope.
  • The approximately 10 percent of non-RCC kidney cancers include transitional cell carcinoma, renal sarcoma, and Wilms’ tumor (nephroblastoma), which affects children.

UTSW investigators have also discovered that patients with kidney cancer may have a high predisposition to develop lung cancer. Specifically, lung cancer was diagnosed in 3 percent of patients with kidney cancer that had metastasized to the lungs (Bowman et al., Clin Genitourin Cancer, 2017). Press Release 

Staging Kidney Cancer

The “stage” of a cancer represents whether it has spread beyond the organ in which it originated, and if so, how far. A cancer’s stage largely influences the treatment that is chosen.

Kidney cancer is staged and evaluated based on the findings of the physical exam, laboratory studies, imaging studies, and sometimes a biopsy (tissue sample). Learn more about kidney cancer staging on the American Cancer Society website.

Active Monitoring 

Not every patient with a renal cancer needs surgery or an intervention. Patients with small tumors (less than 4 cm) are often monitored and may never require surgery. At the KCP, a protocol has been established for careful active monitoring of small renal masses. 

Request an Appointment

To schedule a visit with a kidney cancer specialist at UT Southwestern’s facilities in Dallas or to learn more about our services, request an appointment or call 214-645-8300.