In the past, many RCCs were found at a late stage because they can become quite large without causing any pain or discomfort. Because the kidney is deep inside the body, small kidney tumors cannot be seen or felt by a physical exam. Unfortunately, there are presently no blood or urine tests available that screen for RCC in the general population. Genetic tests looking for the VHL gene mutation are becoming available, but these tests are used to diagnose von Hippel-Lindau disease and not RCC. Genetic testing for VHL disease is used only in people with clinical signs of that condition and their blood relatives.

Patients diagnosed with von Hippel-Lindau disease or tuberous sclerosis may need special x-ray tests to look closely for early signs of kidney cancer. People with kidney diseases treated by long-term dialysis should have periodic x-ray studies of their kidneys or ultrasound to find any RCCs at an early curable stage.

Fortunately, a growing number of RCCs are found "incidentally", meaning that the cancer is found accidentally. An incidental RCC causes no pain or discomfort to the patient but is found during imaging tests for some other illness such as gallbladder disease. The survival rates for incidental kidney cancer is very high when treated appropriately, because these cancers are usually found at a very early stage.

Signs and symptoms of kidney cancer:

• Blood in the urine (hematuria)
• Low back or flank pain
• A mass or lump in the abdomen (belly)
• Fatigue
• Weight loss that is rapid or not intentional
• Fever not associated with a cold, flu, or other infection
• Swelling of ankles and legs (edema)
• High blood pressure (rare)

Medical history physical exam

A complete medical history should check for risk factors and symptoms. A physical exam can provide information about signs of kidney cancer.

Imaging tests

Computed tomography scans: (also known as CT or CAT scans), magnetic resonance imaging (MRI), intravenous pyelogram (IVP), and ultrasonography (also known as ultrasound) are very helpful in the diagnosis of most kinds of kidney tumors.

CT scan: A CT scan is an enhanced x-ray procedure. The x-ray beam moves around the body taking images from different angles. These images are then combined by a computer to produce detailed pictures of the inside of the body.

Magnetic resonance imaging (MRI): MRI uses large magnets and radio waves to produce computer-generated, cross-sectional pictures of internal organs. Ultrasonography: Uses sound waves to look for abnormalities inside the body. The sound waves bounce off internal body parts and report an image, like sonar on a submarine. The sound waves are analyzed by a computer to produce an image. This test is useful in finding out if a kidney abnormality is a cyst (fluid filed sac not likely to be cancer) or a solid tumor (possibly cancerous).

Intravenous pyelogram (IVP): This is an older but often used x-ray procedure where a special dye called contrast, is injected into a vein. The dye is concentrated then secreted by the kidneys and is released in to the urine. The dye shows up white on dark x-rays. IVP can help identify a cancer but it is generally considered less sensitive than a CT scan. Chest x-ray: A chest x-ray is used to find metastasis of cancer to the lungs, or bones of the chest area.

Bone scan: A bone scan uses small amounts of a special radioactive material that identifies metastatic cancer in bones. It may also identify some non-cancerous bone diseases. The levels of radiation used are very low and not harmful. Bone scan are useful when bone pain is present or the blood alkaline phosphotase level is elevated.

Laboratory tests

Urinalysis: Half of patients with RCC will have blood in their urine. Urinalysis is usually part of a complete physical exam but may not be done as a part of more routine physicals. A microscope and chemical tests are used so that even small amounts of blood not seen with the naked eye can be found.

Blood tests: A complete blood count and chemical test of the blood can detect some findings associated with RCC. Anemia (too few red blood cells) may be present because of blood loss. Polycythemia (too many red blood cells, opposite of anemia) may occur because some RCC's produce a hormone that increases red blood cell production by the bone marrow. High levels of enzymes released by the liver (for reasons not known) and hypercalcemia (high calcium levels) are sometimes related to RCC.

Fine needle aspiration (FNA)/ Biopsy: These tests are rarely used in diagnosis of kidney tumors. A thin needle is used to remove fluid or small pieces of tissue from a kidney tumor for examination under a microscope. Although imaging studies usually provide enough information for the surgeon to decide whether or not an operation is needed, fine needle aspiration is occasionally useful valuable when clinical information and/ or imaging results are not conclusive enough to warrant removing a kidney. CT scans are taken during the FNA procedure to help guide the needle into the tumor. The FNA/biopsy typically is very difficult for the pathologist to evaluate and make a diagnosis because the amount of tissue is so limited. The diagnostic inaccuracy is limited that, FNA/biopsy is rarely performed.

Follow-up Tests

Tests should be done based on your cancer's original stage and response to treatment. Chest x-rays, CT scans of the abdomen and chest and other imaging studies may be taken to watch for a local recurrence, metastasis, or for a new tumor. Blood tests to check kidney and liver function may also be obtained. Although different physicians will use a variety of schedules to monitor patients after initial treatment for RCC, at least yearly CT scan of the abdomen, chest x-ray or CT of the chest, liver function tests and complete blood count as well as physical examination should be obtained.