Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- assintomático (achado incidental)
- hematúria
- dor no flanco
- massa abdominal palpável
Other diagnostic factors
- sintomas sistêmicos inespecíficos
- sinais de disfunção hepática
- mioneuropatia
- edema de membros inferiores
- varicocele escrotal
- manifestações dermatológicas (síndromes hereditárias)
- perda da visão (Von Hippel-Lindau)
Risk factors
- tabagismo
- sexo masculino
- idade acima de 55 anos
- residência em países desenvolvidos
- etnia indígena norte-americana não hispânica/nativa do Alasca
- obesidade
- hipertensão
- história familiar positiva de CCR
- história de síndromes hereditárias
- história de doença renal cística adquirida
- exposição a asbesto/cádmio
- história obstétrica/exposição ao estrogênio
- radiação pélvica
Diagnostic investigations
1st investigations to order
- tomografia computadorizada (TC) de abdome/pelve
- tomografia computadorizada (TC) do tórax
- RNM de abdome/pelve
- ultrassonografia abdominal/pélvica
- Hemograma completo
- lactato desidrogenase (LDH)
- cálcio corrigido
- testes da função hepática
- perfil de coagulação
- creatinina
- TFG estimada
- urinálise
Investigations to consider
- ressonância nuclear magnética (RNM) cranioencefálica/da coluna
- cintilografia óssea
- biópsia
- patologia cirúrgica
- avaliação genética
Emerging tests
- tomografia por emissão de pósitrons (PET)
Treatment algorithm
massa renal pequena ou carcinoma de células renais (CCR) em estádio 1 ou 2
carcinoma de células renais (CCR) em estádio 3
carcinoma de células renais (CCR) em estádio 4 (doença metastática)
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.
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.
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
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.
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