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Renal cell carcinoma
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Renal cell carcinoma

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Contributors: Amirah Khan MD, Christine Osborne MD, Catherine Moore MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Renal cell carcinoma (RCC) accounts for the majority of malignant neoplasms arising from the kidney. RCC is often asymptomatic until significant disease advancement, with 1 in 4 patients having advanced local disease or distant metastasis at presentation. Peak incidence is between the ages of 50 and 70 years, with a male-to-female ratio of 2:1. Risk factors for development of RCC include cigarette smoking, acquired cystic disease of the kidney, hypertension, obesity, occupational exposure (asbestos, cadmium, lead, petrochemicals), and von Hippel-Lindau syndrome.

The most common type of RCC is clear cell carcinoma, accounting for 75% of cases. Other categories include bilateral and multifocal papillary tumors (10%), chromophobe tumors (5%), benign oncocytomas (3%-7%), and rare but aggressive Bellini duct tumors (< 1%). Hereditary leiomyomatosis and renal cell cancer (HLRCC) is a disorder that causes benign tumors of smooth muscle in the skin and uterus. It increases the risk of papillary RCC at an early age and should be considered in those with family history of RCC.

Clinical presentation includes hematuria, abdominal pain, flank mass or abdominal mass, fever, weight loss, anemia, or varicocele. Many patients have tumors discovered incidentally with abdominal imaging performed for another reason.

Paraneoplastic manifestations of RCC include hypercalcemia, production of adrenocorticotrophic hormone, polycythemia, hepatic dysfunction, thrombocytosis, secondary AA amyloidosis, fever, and weight loss in 20% of individuals.

Mortality from RCC has been declining due to earlier detection.

Codes

ICD10CM:
C64.9 – Malignant neoplasm of unspecified kidney, except renal pelvis

SNOMEDCT:
702391001 – Renal cell carcinoma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Complex renal cyst
  • Renal angiomyolipoma
  • Oncocytoma
  • Metanephric adenoma
  • Xanthogranulomatous pyelonephritis, a rare form of pyelonephritis involving chronic inflammation
  • Metastatic disease

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 06/20/2019
Last Updated: 06/21/2019
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Renal cell carcinoma
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Renal cell carcinoma : Fever, Flank pain, Abdominal mass, Ascites, Hematuria, Varicocele, Weight loss, Anemia, Ca elevated
Imaging Studies image of Renal cell carcinoma
Unenhanced axial CT scan of the abdomen and pelvis with solid mass at the lower pole in right kidney, consistent with renal cell carcinoma.
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