Renal Cell Carcinoma: Diagnosis and Management

Richard E. Gray, DO; Gabriel T. Harris, MD

Disclosures

Am Fam Physician. 2019;99(3):179-184. 

In This Article

Abstract and Introduction

Abstract

Kidney cancer is one of the 10 most common cancers in the United States with 90% being attributed to renal cell carcinoma. Men, especially black men, are more likely to be affected than women. Renal masses, either cystic or solid, are best detected with contrast-enhanced, triple-phase computed tomography. Renal tumors are often detected incidentally during a computed tomography scan of the abdomen or chest that was ordered for unrelated symptoms. Hematuria serves as a warning sign that necessitates further evaluation and imaging leading to a diagnosis and treatment plan. Treatment options include active surveillance, ablation, nephron-sparing tumor excision, nephrectomy, and systemic treatment. Predictors of a poor prognosis include poor functional status and metastasis. In recent years new therapies have improved the prognosis for patients with metastatic disease. The family physician should be aware of risk factors (e.g., hypertension, tobacco use, exposure to trichloroethylene, familial syndromes) and lifestyle and dietary modifications that may reduce risk. (Am Fam Physician. 2019; 99(3): 179–184. Copyright © 2019 American Academy of Family Physicians.)

Introduction

Kidney cancer is one of the 10 most common cancers in the United States.[1] Renal cell carcinoma accounts for 90% of all kidney cancers.[2] Death attributed to renal cell carcinoma accounted for 2% of all cancer deaths or approximately 14,000 persons in 2016.[1,2] Men are diagnosed with renal cell carcinoma at almost twice the rate of women, and there is a greater prevalence in black men.[3] Most cases are diagnosed between 60 and 70 years of age.[1,2]

Renal cell carcinoma is classified in three major histological subtypes: clear cell (75%), papillary (15% to 20%), and chromophobe (5%).[4] Disease-specific survival is worst with clear cell renal cell carcinoma as it tends to be discovered at a more advanced stage.[5]

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