Clinical Aspects of Renal Cell Carcinoma

Renal cell carcinoma (RCC) represents a heterogeneous group of tumors, the most common of which is clear cell adenocarcinoma. RCC accounts for 3% of adult tumors. The incidence has increased more than 30% over the past two decades. It is generally postulated that the increased incidence rates reflect earlier diagnosis at an earlier stage, largely due to more liberal use of radiological imaging techniques. However, advanced disease has also been diagnosed more frequently and the mortality rate has increased as well. Prevention of RCC should focus on smoking cessation and maintaining ideal body mass index. Familial forms of kidney cancer have been described on four distinct histological patterns: clear cell, papillary, chromophobe, and oncocytoma. Genetic forms afflict individuals at an earlier age with a multifocal and recurrent pattern; therefore, nephron-sparing procedures should be the treatment of choice for these patients. The yield of screening the general population for RCC is still relatively low and hence not cost-effective. Screening should be reserved for individuals who carry high risk for RCC. The classic triad of flank pain, macroscopic hematuria, and palpable abdominal mass is now detected in fewer than 10% of patients, and is a late sign. Today, most tumors are diagnosed incidentally. Paraneoplastic syndromes have been reported in 10–40% of patients and can be seen at any stage of disease. The indications and application of percutaneous biopsy for renal masses are limited and mainly used to make differential diagnosis with an infectious process, lymphoma and metastases to the kidney.