Jean Robey, MD, is a board certified physician in the fields of Internal Medicine and Nephrology on staff at Banner Estrella Medical Center.
Question: My mother has a history of diabetes and was recently was diagnosed with cancer involving her right kidney and ureter. Would routine testing have detected her cancer?
Answer: The National Cancer Institute estimates that between 2001 – 2007, the age-adjusted incidence rate for cancer involving the kidney and renal pelvis was 13.2 per 100,000 men and women per year. This incidence varies with demographics.
The kidneys are located in the back compartment of the abdominal cavity. Their location often results in cancers detected only after extensive progression. Some patients may exhibit no symptoms, or generalized symptoms like fatigue or weight loss due to hormone production by the cancer. Some might exhibit overt symptoms like pain in the flanks due to actual pressure exerted by the mass, obstruction of urine by the mass, or visible blood in the urine.
It can be difficult to differentiate if the pain is caused by other problems like muscular skeletal pain, vertebral nerve impingement, kidney stones with obstruction, kidney infection or other organ involvement either in the same area or referred to the area.
Routine analysis of urine may be bland or identify cells, blood or protein. However, abnormal sediment in the urine cannot be differentiated from inflammation or infection in the bladder, urinary tract or kidneys or damage due to kidney or bladder stones. Only special pathological analysis of urine can find abnormal cancer cells. These are only successful in identifying cancer cells when cancer cells are being shed.
Routine lab work in diabetic patients includes evaluation of kidney filtration and urine sediment primarily for abnormal protein excretion at least annually. These same labs may, but not always be abnormal in diabetics with kidney or urinary tract cancers.
Regardless of your other medical problems, if you have signs of flank pain, blood in your urine, recurrent urine infections or abnormal lab work that indicates decreased kidney filtration, microscopic blood or massive amounts of protein in your urine, further imaging may be appropriate either by ultrasound or CT scan to determine the nature of your symptoms and to evaluate your kidneys and urinary tract.