Renal Cell Carcinoma (RCC) - Diagnosis and Management Summary

Clinical features - Classic triad (flank pain, hematuria, and a palpable abdominal renal mass): 9% of patients- when present suggests locally advanced disease

1. Hematuria (most common)

2. Anemia (common)

3. Colicky flank pain (CLOT COLIC)

4. Potentially palpable renal mass

5. Weight loss, fatigue, night sweats, fever

6. Secondary Amyloidosis

7. Varicocele(left)

8. Budd Chiari syndrome (involvement IVC)

9. Symptoms of metastatic disease

Imaging and Treatment - Best initial test: abdominal CT scan with contrast

Evaluation of metastatic disease:

1.  CT/MRI of the thorax

2. Bone scan is indicated for patients with bone pain and ↑ ALP

RCC is highly resistant to chemotherapeutic agents → MDR-1 express

Laboratory tests

1. Urinalysis: hematuria

2. Hb levels and CBC

3. Hypercalcemia

4. ↑ AST, ALT, and/or ALP

5. BUN/creatinine

6. Percutaneous renal biopsy generally not recommended.

Rx of choice: surgery. Unfit: treated palliatively with

arterial embolizationand external beam radiotherapy

Othertherapies: Interferon-a (immunotherapy), Recombinant cytokines (e.g., interleukin-2), Tyrosine kinase inhibitors (e.g., sorafenib, sunitinib, pazopanib)



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