Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presencia de factores de riesgo
- asintomático (hallazgo incidental)
- hematuria
- dolor en fosa lumbar
- masa abdominal palpable
Outros fatores diagnósticos
- síntomas sistémicos inespecíficos
- signos de disfunción hepática
- neuromiopatía
- edema de las extremidades inferiores
- varicocele en el escroto
- manifestación dermatológica (síndromes hereditarios)
- pérdida de la visión (von Hippel-Lindau)
Fatores de risco
- tabaquismo
- sexo masculino
- de más de 55 años de edad
- residencia en países desarrollados
- Etnia indígena estadounidense no hispana/nativa de Alaska
- obesidad
- hipertensión
- antecedentes familiares positivos para CCR
- antecedentes de síndromes hereditarios
- antecedentes de enfermedad renal quística adquirida
- exposición al asbesto/cadmio
- antecedentes obstétricos y exposición a estrógenos
- radiación pélvica
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- TC de abdomen o de pelvis
- tomografía computarizada (CT) de tórax
- resonancia magnética (IRM) de abdomen o pelvis
- ultrasonido de abdomen o pélvico
- hemograma completo (HC)
- lactato deshidrogenasa (LDH)
- calcio corregido
- pruebas de función hepática
- perfil de coagulación
- creatinina
- TFG estimada
- análisis de orina
Investigações a serem consideradas
- resonancia magnética (IRM) cerebral o de columna
- gammagrafía ósea
- biopsia
- patología quirúrgica
- evaluación genética
Novos exames
- exploración por tomografía por emisión de positrones (TEP)
Algoritmo de tratamento
masa renal pequeña o carcinoma de células renales (CCR) en etapa 1 o 2
carcinoma de células renales (CCR) en etapa 3
carcinoma de células renales (CCR) en etapa 4 (enfermedad metastásica)
Colaboradores
Autores
Rodrigo R. Pessoa, MD, PhD
Urology Fellow
Department of Urology
Mayo Clinic
Rochester
MN
Declarações
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
Declarações
SK declares that he has no competing interests.
Agradecimentos
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.
Declarações
AYS has an unpaid advisory role for Merck pharmaceuticals. SG and JJK declare that they have no competing interests.
Revisores
Stephen A. Boorjian, MD
Assistant Professor
Fox Chase Cancer Center
Philadelphia
PA
利益声明
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
利益声明
TJG declares that he has no competing interests.
Jonathan Waxman, BSc, MBBS, MD, FRCP
Professor of Oncology
Imperial College
London
UK
利益声明
JW declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
American Urological Association. Renal mass and localized renal cancer: evaluation, management, and follow up. 2021 [internet publication].全文
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.全文 摘要
European Association of Urology. Renal cell carcinoma. 2023 [internet publication].全文
American College of Radiology. ACR appropriateness criteria: post-treatment follow-up and active surveillance of clinically localized renal cell carcinoma. 2021 [internet publication].全文
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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