Renal cell carcinoma (RCC) is a malignancy arising from the renal parenchyma/cortex. Clear cell RCC accounts for the majority (80% to 90%) of primary renal malignancies.
Incidence is increasing along with stage migration to more early-stage diagnosis due to the frequent use of sensitive imaging. Often asymptomatic and diagnosed incidentally.
Most cases are sporadic, although at least four hereditary clinical kidney cancer syndromes have been identified.
Assessment of primary tumor, regional lymph nodes, distant metastasis, and classification of histologic subtypes are of paramount importance for making treatment decisions.
Surgery for early/local disease can be curative in over 90% of patients; surveillance and/or biopsy may be the most appropriate strategy in some patients with small renal masses. Risk of distant relapse remains 30% for curatively resected RCC.
Metastatic disease has traditionally had poor 5-year survival (10%). However, targeted systemic therapies have revolutionized treatment for metastatic disease, with median overall survival improving across all risk groups. Combination therapy (dual immune checkpoint inhibitors or an immune checkpoint inhibitor plus a tyrosine kinase inhibitor) is now recommended as first-line therapy.
Future directions in management include integrating molecular biomarkers into prognostic models and evaluating new imaging modalities for assessing treatment response.
History and exam
Key diagnostic factors
- asymptomatic (incidental finding)
- flank pain
- palpable abdominal mass
Other diagnostic factors
- nonspecific systemic symptoms
- signs of hepatic dysfunction
- lower limb edema
- scrotal varicocele
- dermatologic manifestation (hereditary syndromes)
- vision loss (von Hippel Lindau)
- male sex
- age over 55 years
- residence in developed countries
- black/American-Indian ethnicity
- positive family history of RCC
- history of hereditary syndromes
- history of acquired renal cystic disease
- obstetric history/estrogen exposure
- pelvic radiation
1st investigations to order
- corrected calcium
- liver function tests
- coagulation profile
- estimated GFR
- abdominal/pelvic ultrasound
- CT abdomen/pelvis
- MRI abdomen/pelvis
Investigations to consider
- CT chest
- MRI brain/spine
- bone scan
- surgical pathology
- genetic evaluation
- PET scan
small renal mass or RCC stage 1 or 2
RCC stage 3
RCC stage 4 (metastatic disease)
- Benign renal cyst
- Ureteric cancer
- Bladder cancer
- NCCN clinical practice guidelines in oncology: kidney cancer
- Renal cell carcinoma
Kidney cancerMore Patient leaflets
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