Kidney cancer diagnosis one-stop clinic (involving an image guided biopsy)

What is this clinic for?

You have been referred to urology after a scan which showed a suspicious area in your kidney that could be a kidney cancer. This one-stop clinic involves a consultation with the kidney team and a biopsy on the same day to confirm whether this area is a kidney cancer or not.

What does the procedure involve?

Puncture of the skin, under local anaesthetic and image guidance, to get a sample from the lump in the kidney, called a needle biopsy.

What are alternatives to the biopsy?

• Surgical removal of kidney / part of the kidney
• Surveillance of the kidney lump
• Radiological ablation of kidney lesion. Using a needle to the kidney lump and heating or freezing to kill cancer cells.
• Please speak to your consultant and specialist nurse if you would like to discuss alternative options.

What should I expect before the procedure?

You should arrange for someone to drive you home and stay with you overnight, as you will be unable to drive for 24 - 48 hours after the procedure. If you have difficulty organising this, please inform your specialist nursing team as soon as possible.

Please be sure to inform your urologist in advance if you have any of the following:

• artificial heart valves
• coronary artery stents
• a heart pacemaker or defibrillator
• an artificial joint
• an artificial blood vessel graft
• a neurosurgical shunt
• any other implanted foreign body
• a previous or current MRSA infection
• or have a high-risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or a previous injection of human-derived growth hormone).

Warfarin or bleeding tendencies (such as haemophilia or platelet abnormalities) may mean we cannot go ahead with the procedure If you are taking a prescription for warfarin, rivaroxaban, dabigatran, apixaban, edoxaban, clopidogrel, ticagrelor or other blood-thinning medication, you should ensure that the urology staff are aware of this well in advance of your admission. If you have a tendency to bleed, please arrange to discuss this with your consultant before the biopsy procedure.

If you are taking any blood-thinning medication, please inform your kidney team and the Radiology Day Unit and be guided by the Radiology Day Unit. When your appointment is booked, you will be sent a letter with clear instructions to advise on your anticoagulation medications.

What does the biopsy involve?

Please come to the Radiology Day Unit, on level 3, outpatients department, as detailed in your appointment letter.

You will be admitted to the Radiology Day Unit for the procedure.

During the morning a member for the Kidney Specialist Nurses team will see you in the department.

You will need to be available for the whole day to complete the consultation and biopsy.

The procedure is usually performed in either the ultrasound department or in the CT scanning department.

We advise you not to bring any valuables with you.

Normally, a local anaesthetic injection will be used to numb the skin.

The procedure then involves guidance by imaging to locate the lump on your kidney. A special needle is then inserted and passed into the lump on your kidney, where one or more samples may be taken.

What happens immediately after the biopsy?

After the procedure, you will return to the ward, where you will be monitored. Your blood pressure and pulse will be measured regularly and you will be observed carefully for any signs of bleeding from the biopsy site.

You will be able to return home as soon as you feel well enough.

The average length of stay is one day.

Before you’re discharged home, you will see your kidney consultant and specialist nurse to discuss the result of the biopsy. If kidney cancer is confirmed, the team will advise you about the available treatment and support options. The specialist nurse will give you information packs and arrange a follow-up appointment to finalise your treatment decision. You will then be able to go home.

Are there any side effects?

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than one in 10)

☐ Slight discomfort at the biopsy site

☐ Skin bruising around the biopsy site

Occasional (between one in 10 and one in 50)

☐ Occasionally, more than one puncture site is required to obtain an adequate biopsy

☐ The biopsy may fail to sample the tissue in which we are interested

☐ It may not be possible to make firm diagnosis on the basis of this biopsy so there
may be a need for further biopsies or other diagnostic procedures

Rare (less than one in 50)

☐ It may not be possible to make firm diagnosis on the basis of this biopsy so there
may be a need for further biopsies or other diagnostic procedures

☐ Damage to other internal organs requiring further intervention

What should I expect when I get home?

When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your procedure. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

When you get home, especially after a kidney biopsy, you should drink twice as much fluid as you would normally to flush your system through and to minimise any bleeding. Any discomfort at the biopsy site should normally settle within a few days.

What else should I look out for?

If you develop a fever, severe pain or feel faint, you should contact your GP immediately.

Out of hours please come to A+E or call 111.

Other information

This patient information leaflet provides input from specialists, the British Association of Urological Surgeons, the Department of Health and evidence-based sources as a supplement to any advice you may already have been given by your GP. Alternative treatments can be discussed in more detail with your urologist or specialist nurse.

We encourage the use of MyChart, an electronic system. Through this you are updated of your appointments and sent clinic letters. You can also send a message for appointment queries and advice direct to your clinical team. Please talk to either the reception staff or specialist nursing team for more information.

Urology nurse specialist and Kidney cancer nurse practitioner

Mychart message or Telephone message on 01223 274608

Patient advice and liaison service (PALS)

Call Patient advice and liaison service (PALS) on 01223 216756

Call PatientLine on *801 (from patient bedside telephones only)

Email PALS

Chaplaincy and multi faith community

Call the Chaplaincy and multi faith community on 01223 217769

Email the chaplaincy team

Call the MINICOM System (‘type’ system for the hard of hearing) on 01223 217589

Access office (travel, parking and security information)

Call the Access office (travel, parking and security information) on 01223 596060