When are biopsies important in detecting kidney cancer?

kidney cancermCancerPartner sat down recently with Khaled S. Hafez, M.D., a surgeon and associate professor of urology, to discuss how kidney cancer is detected and the role biopsies play.

mCancerPartner: What are the symptoms of kidney cancer?

Dr. Hafez: The three symptoms that normally indicate kidney cancer are pain in the abdomen, blood in the urine and a mass, or growth, in the side. But how physicians find kidney cancer has changed in recent years. Today, most kidney cancer is found accidently, before the symptoms begin to show. Most patients come in for a different reason, such as chest pain, a kidney stone, etc., then we find that they have a kidney mass as well. This is how the majority of kidney cancers are diagnosed today.

mCancerPartner:  When should a patient get a biopsy?

Dr. Hafez: In order to understand when a patient should get a biopsy, it is important to understand the history behind biopsies. In the past 20 years, we have made tremendous strides in biopsy accuracy. However, although accuracy has improved to about 90%, we never want to risk a false negative. Biopsies should only be used when they will change the course of action. If a patient is presenting with large tumors, we would skip the biopsy because it would not change the course of treatment. We use biopsy when patients present with small lesions (less than four centimeters, or smaller than 1.5 inches), to rule out surgery, or if the patient is against intervention. We would most likely preform a biopsy when there is an atypical mass as well. When a patient comes in with multiple tumors in the kidney, we would biopsy the masses in order to see if they are benign or cancerous.

mCancerPartner:  How common is it for patients to get a biopsy to confirm a cancer diagnoses?

Dr. Hafez: Again, this really differs from patient to patient. Overall, kidney cancer is size dependent. The bigger the mass, the more likely it is to be cancerous. Therefore, if a patient presented with a large tumor, we would skip the biopsy. However, when the patient presents with small tumors (less than four centimeters), we want to ensure that surgery is absolutely necessary and would get a biopsy to confirm cancer. So I would say about half of all newly diagnosed cases will get a biopsy.

mCancerPartner:  Why is a biopsy so important when it comes to treating cancer?

Dr. Hafez: A biopsy is only important for certain situations and particular patients. There are three situations where a biopsy is vital to patient care.

  • Situation 1: An unusual appearing masses in patients that typically do not present with kidney cancer.
  • Situation 2: When the cancer has spread outside the patient’s kidney. In cases where the cancer has spread, we would most likely preform a biopsy to confirm that surgery is necessary. We only want to perform surgery when it is beneficial to the patient.
  • Situation 3: To confirm cancer with a small mass or in a patient that has a high risk for surgery.

mCancerPartner:  What is the best type of treatment for kidney cancer?

Dr. Hafez: The standard of care to achieve cure is surgery. There are two options, either to remove the whole kidney or to remove part of the kidney. When operating on patients, we choose to either perform the surgery robotically or the open approach. How we operate depends on the patient and their needs.

mCancerPartner: If someone is newly diagnosed with kidney cancer, what message would you have for them?

Dr. Hafez: The outcome of the disease depends on the stage of cancer. In the low stages, the survival rate is very high. Additionally, most kidney cancer is not familial, so there is only a slim chance that anyone in your family will develop kidney cancer. Lastly, smoking is large risk factor for kidney cancer, so it is imperative that you stop smoking if you smoke.

Take the next step:

  • Learn more about kidney cancer from the American Cancer Society.
  • Call our cancer nurses at the Cancer AnswerLine ™ if you still have questions. Call 1-800-865-1125 or e-mail from anywhere in the country. Nurses are available 8 a.m. to 5 p.m., ET, Monday through Friday. Your call is always free and confidential.

Khaled S. HafezKhaled S. Hafez, M.D., is an associate professor of Urology. He joined the faculty of the UMHS Department of Urology in 2004, initially splitting his time between the Medical School and the VA Ann Arbor Healthcare System. His clinical research focuses on renal cancer and the role of nephron sparing surgery as well as bladder and testicular malignancies. Dr. Hafez has multiple basic science projects investigating renal physiology, oncology and immunology as well as multiple clinical trials for adjuvant therapy in high risk localized renal cancer patients.


University of Michigan Comprehensive Cancer CenterThe University of Michigan Comprehensive Cancer Center’s 1,000 doctors, nurses, care givers and researchers are united by one thought: to deliver the highest quality, compassionate care while working to conquer cancer through innovation and collaboration. The center is among the top-ranked national cancer programs, and #1 in Michigan for cancer patient care. Seventeen multidisciplinary clinics offer one-stop access to teams of specialists for personalized treatment plans, part of the ideal patient care experience. Patients also benefit through access to promising new cancer therapies.