Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic (incidental finding)
- hematuria
- flank pain
- palpable abdominal mass
Other diagnostic factors
- nonspecific systemic symptoms
- signs of hepatic dysfunction
- myoneuropathy
- lower limb edema
- scrotal varicocele
- dermatologic manifestation (hereditary syndromes)
- vision loss (von Hippel-Lindau)
Risk factors
- smoking
- male sex
- age over 55 years
- residence in developed countries
- non-Hispanic American Indian/Alaska Native ethnicity
- obesity
- hypertension
- positive family history of RCC
- history of hereditary syndromes
- history of acquired renal cystic disease
- asbestos/cadmium exposure
- obstetric history/estrogen exposure
- pelvic radiation
Diagnostic tests
1st tests to order
- CT abdomen/pelvis
- CT chest
- MRI abdomen/pelvis
- abdominal/pelvic ultrasound
- CBC
- LDH
- corrected calcium
- liver function tests
- coagulation profile
- creatinine
- estimated GFR
- urinalysis
Tests to consider
- MRI brain/spine
- bone scan
- biopsy
- surgical pathology
- genetic evaluation
Emerging tests
- PET scan
Treatment algorithm
small renal mass or RCC stage 1 or 2
RCC stage 3
RCC stage 4 (metastatic disease)
Contributors
Authors
Rodrigo R. Pessoa, MD, PhD
Urology Fellow
Department of Urology
Mayo Clinic
Rochester
MN
Disclosures
RRP declares that he has no competing interests.
Simon Kim, MD, MPH
Associate Professor of Surgery
Associate Program Director
Anschutz Medical Campus
University of Colorado
UCSOM Division of Urology
Denver
CO
Disclosures
SK declares that he has no competing interests.
Acknowledgements
Dr Rodrigo R. Pessoa and Dr Simon Kim would like to gratefully acknowledge Dr Amishi Y. Shah, Dr Sonal Gandhi, and Jennifer J. Knox, previous contributors to this topic.
Disclosures
AYS has an unpaid advisory role for Merck pharmaceuticals. SG and JJK declare that they have no competing interests.
Peer reviewers
Stephen A. Boorjian, MD
Assistant Professor
Fox Chase Cancer Center
Philadelphia
PA
Disclosures
SAB has been reimbursed by Pfizer for serving on its speakers bureau. SAB is co-author of a reference cited in this topic.
Thomas J. Guzzo, MD, MPH
Assistant Professor of Urology and Surgery
The Hospital of the University of Pennsylvania
Philadelphia
PA
Disclosures
TJG declares that he has no competing interests.
Jonathan Waxman, BSc, MBBS, MD, FRCP
Professor of Oncology
Imperial College
London
UK
Disclosures
JW declares that he has no competing interests.
References
Key articles
American Urological Association. Renal mass and localized renal cancer: evaluation, management, and follow up. 2021 [internet publication].Full text
Escudier B, Porta C, Schmidinger M, et al. Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2019 May;30(5):706-20.Full text Abstract
European Association of Urology. Renal cell carcinoma. 2023 [internet publication].Full text
National Cancer Comprehensive Network. NCCN clinical practice guidelines in oncology: kidney cancer [internet publication].Full text
American College of Radiology. ACR appropriateness criteria: post-treatment follow-up and active surveillance of clinically localized renal cell carcinoma. 2021 [internet publication].Full text
Rathmell WK, Rumble RB, Van Veldhuizen PJ, et al. Management of metastatic clear cell renal cell carcinoma: ASCO guideline. J Clin Oncol. 2022 Sep 1;40(25):2957-95.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Benign renal cyst
- Ureteric cancer
- Bladder cancer
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: kidney cancer
- Management of metastatic clear cell renal cell carcinoma
More GuidelinesPatient information
Kidney cancer
More Patient information
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