Diagnosis and Staging

Symptoms

This information has been reproduced with the  permission of the EAU Guidelines Office.

Many renal masses are asymptomatic and non-palpable until the late stages of the disease¹. Currently, more than 50% of RCCs are detected incidentally by using imaging to investigate a variety of non-specific symptom complexes^2-4 (level of evidence: 2b). The classic triad of flank pain, gross haematuria and palpable abdominal mass is now rare (6-10%)^5,6 (level of evidence: 3).

Paraneoplastic syndromes are found in approximately 30% of patients with symptomatic RCCs (Table 3) (level of evidence: 4). A few symptomatic patients present with symptoms due to metastatic disease, such as bone pain or persistent cough^1,7 (level of evidence: 2b).

Table 3: Most common paraneoplastic syndromes.

References:
1. Novick AC, Bukowski RM, Campbell SC. Renal tumours. In: Wein AJ, Kavoussi LR, Novick AC, Partin AV, Peters CA (eds). Campbell-Walsh Urology. Philadelphia: WB Saunders, 2007: pp. 1565-638.
2. Kutikov A, Fossett LK, Ramchandani P, Tomaszewski JE, Siegelman ES, Banner MP, Van Arsdalen KN, Wein AJ, Malkowicz SB. Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology 2006 Oct;68(4):737-40. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/17070344
3. Remzi M, Ozsoy M, Klingler HC, Susani M, Waldert M, Seitz C, Schmidbauer J, Marberger M. Are small renal tumors harmless? Analysis of histopathological features according to tumors 4 cm or less in diameter. J Urol 2006 Sep;176(3):896-9. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/16890647
4. Kane CJ, Mallin K, Ritchey J, Cooperberg MR, Carroll PR. Renal cell cancer stage migration: analysis of the National Cancer Data Base. Cancer 2008 Jul;113(1):78-83.
http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/18491376
5. Lee CT, Katz J, Fearn PA, Russo P. Mode of presentation of renal cell carcinoma provides prognostic information. Urol Oncol 2002 Jul-Aug;7(4):135-40. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/12474528
6. Patard JJ, Leray E, Rodriguez A, Rioux-Leclercq N, Guille F, Lobel B. Correlation between symptom graduation, tumor characteristics and survival in renal cell carcinoma. Eur Urol 2003 Aug;44(2):226-32. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/12875943
7. Kim HL, Belldegrun AS, Freitas DG, Bui MH, Han KR, Dorey FJ, Figlin RA. Paraneoplastic signs and symptoms of renal cell carcinoma: implications for prognosis. J Urol 2003 Nov;170(5):1742-6. http:/anti-infectives/Paris-Event/Live-Webcast.cfmwww.ncbi.nlm.nih.gov/pubmed/14532767