Clinical manifestations, evaluation, and staging of renal cell carcinoma
- Michael B Atkins, MD
Michael B Atkins, MD
- Section Editor — Malignant Melanoma and Other Cutaneous Neoplasms; Cancer of the Kidney
- Deputy Director
- Georgetown Lombardi Comprehensive Cancer Center
Malignant neoplasms involving the kidney may be primary or secondary tumors. Secondary renal neoplasms are usually clinically insignificant and discovered at postmortem examination.
Renal cell carcinomas (RCCs), which originate within the renal cortex, constitute 80 to 85 percent of primary renal neoplasms. Transitional cell carcinomas of the renal pelvis are the next most common (approximately 8 percent). Other parenchymal epithelial tumors, such as oncocytomas, collecting duct tumors, and renal sarcomas, are rare. Nephroblastoma or Wilms' tumor is common in children (5 to 6 percent of all primary renal tumors). (See "Epidemiology, pathology, and pathogenesis of renal cell carcinoma" and "Malignancies of the renal pelvis and ureter".)
The clinical and radiographic presentation of RCC and the methods used for tumor staging, as well as their potential application for screening, will be reviewed here. The prognosis and treatment of RCC are discussed separately. (See "Prognostic factors in patients with renal cell carcinoma".)
Patients with renal cell carcinoma (RCC) can present with a range of symptoms; unfortunately, many patients are asymptomatic until the disease is advanced. At presentation, approximately 25 percent of individuals either have distant metastases or advanced locoregional disease .
Patients with localized disease can present with a wide array of symptoms and/or laboratory abnormalities, or they may be diagnosed incidentally. In a 1971 review of 309 consecutive patients with RCC, the most common presenting symptoms were hematuria, abdominal mass, pain, and weight loss . In contemporary series, fewer patients have the typical symptoms and there is an increased frequency of incidental diagnosis due to radiologic procedures performed for other indications. (See "Epidemiology, pathology, and pathogenesis of renal cell carcinoma", section on 'Epidemiology'.)
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- CLINICAL MANIFESTATIONS
- Symptoms and signs
- Paraneoplastic symptoms
- - Anemia
- - Hepatic dysfunction
- - Fever
- - Hypercalcemia
- - Cachexia
- - Erythrocytosis
- - AA amyloidosis
- - Thrombocytosis
- - Polymyalgia rheumatica
- DIAGNOSTIC EVALUATION
- Radiographic testing
- Other imaging tests
- TISSUE DIAGNOSIS
- STAGING IMAGING STUDIES
- TNM STAGING SYSTEM
- SOLID RENAL MASSES
- INFORMATION FOR PATIENTS