15th July 2024

Renal malignancy

Around half of all renal cancers are incidental findings on imaging, a virtue of being asymptomatic. Renal cell carcinoma (RCC) accounts for the majority of renal malignancies. It is an adenocarcinoma arising from the tubular epithelium. There is a classical triad of pain, haematuria and a palpable mass which is seen in less than 10%. Pain occurs due to capsular stretching, whilst haematuria occurs on invasion of the collecting system. Scrotal varices on the left more than the right is also a classical sign. Clear cell renal cell carcinoma is the most common cause of primary renal tumours.

Diagnosis is often made with USS, followed by CT and/or MRI. PET can be used to detect occult metastases. Definitive diagnosis is made using CT-guided biopsy most commonly.

Radical surgery is often curative and is the aim of treatment in the majority of cases, unless widespread metastasis has occurred. Nephrectomy can be radical or partial. Immunotherapy and chemotherapy also play a role, however this is dependent on the type of tumour present.