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Renal cell carcinoma

Last reviewed: 9 Nov 2023
Last updated: 13 Jun 2023



History and exam

Key diagnostic factors

  • asymptomatic (incidental finding)
  • hematuria
  • flank pain
  • palpable abdominal mass
More key diagnostic factors

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)
Other diagnostic factors

Risk factors

  • smoking
  • male sex
  • age over 55 years
  • residence in developed countries
  • black/American-Indian ethnicity
  • obesity
  • hypertension
  • positive family history of RCC
  • history of hereditary syndromes
  • history of acquired renal cystic disease
  • asbestos/cadmium
  • obstetric history/estrogen exposure
  • pelvic radiation
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • LDH
  • corrected calcium
  • liver function tests
  • coagulation profile
  • creatinine
  • estimated GFR
  • urinalysis
  • abdominal/pelvic ultrasound
  • CT abdomen/pelvis
  • MRI abdomen/pelvis
More 1st investigations to order

Investigations to consider

  • CT chest
  • MRI brain/spine
  • bone scan
  • biopsy
  • surgical pathology
  • genetic evaluation
More investigations to consider

Emerging tests

  • PET scan

Treatment algorithm


small renal mass or RCC stage 1 or 2

RCC stage 3

RCC stage 4 (metastatic disease)



Rodrigo R. Pessoa, MD, PhD

Urology Fellow

Department of Urology

Mayo Clinic




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 




SK declares that he has no competing interests.


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.


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




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




TJG declares that he has no competing interests.

Jonathan Waxman, BSc, MBBS, MD, FRCP

Professor of Oncology

Imperial College




JW declares that he has no competing interests.

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  • Guidelines

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