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Laboratory Tests and Ancillaries
Initial laboratory studies include complete blood cell count (CBC) with differential, electrolytes, serum lactate dehydrogenase (LDH), liver function tests (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]), renal profile, serum corrected calcium and urinalysis. Urine cytology should be considered if urothelial carcinoma is suspected. Genetic evaluation should be done for patients with multiple tumors or who are <46 years of age.
Imaging
Imaging studies are essential for the evaluation and staging of renal
masses, as well as for therapeutic planning.
Bone Scan
A bone scan is only indicated in patients with bone pain and/or
an elevated serum alkaline phosphatase.
Chest X-ray
A chest X-ray is an essential part of the patient's initial
work-up.
Computed Tomography (CT) Scan
Computed tomography scans can differentiate cystic masses from
solid masses. It supplies information about lymph node, renal vein and inferior
vena cava involvement. It is the main modality for the assessment of renal
masses, with pre- and post-contrast enhanced scanning of the abdomen, pelvis and
chest. An abdominal CT scan primarily determines the extent of local and
regional involvement. On the other hand, a chest CT scan evaluates the presence
of pulmonary or mediastinal lymph node metastases.
Renal Cancer_Diagnostics
Intravenous Pyelogram (IVP)
An intravenous pyelogram is a series of X-rays of the kidneys,
ureters and bladder taken to find out if cancer is present in these organs.
Magnetic Resonance Imaging (MRI) Scan
Magnetic resonance imaging scans are used to evaluate the
inferior vena cava and right atrium for tumor involvement. This is helpful in
cases of renal insufficiency or contrast allergy preventing the use of IV
contrast. It may also be used in the assessment of IVC thrombus or in
clarifying the anatomy of individual renal lesions. The MRI of the brain may be
performed if clinical signs, symptoms and presentation suggest brain metastases.
Percutaneous Biopsy
Percutaneous biopsy is used in the evaluation of potentially
malignant cystic renal lesions detected by ultrasound or CT scan. It may also
be used for small renal masses if there is a high index of suspicion for a
metastatic lesion to the kidney, lymphoma or a focal kidney infection. It may
be considered when a central renal mass is present suggestive of urothelial
carcinoma if with metastatic disease or if the patient cannot tolerate
ureteroscopy.
Positron Emission Tomography (PET) Scan
Positron emission tomography scan is used in the evaluation of
lymph node involvement and to measure the area of metastasis. It has high
sensitivity and specificity for primary lesions.
Ultrasonography
Ultrasonography initially detects renal tumors and distinguishes
a simple benign cyst from a complex cyst or a solid tumor. Detection of tumors
depends on the size, location and echogenicity of the lesion.
Ureteroscopy
Ureteroscopy may be considered when a central renal mass is
present and suggestive of urothelial carcinoma.