Renal Cell Cancer

Renal Cell Cancer (RCC) constitutes 85% of the primary renal neoplasms. Many patients are asymptomatic until the disease is advanced.

Symptoms of RCC
The classic triad of RCC consists of flank pain, hematuria, and palpable abdominal mass. (Now rare at presentation)
Patients could also have scrotal varicoceles and inferior vena cava (IVC) involvement. IVC involvement can lead to lower extremity edema, ascites, hepatic dysfunction and even pulmonary embolism.

Many patients eventually develop a paraneoplastic syndrome (systemic symptoms due to ectopic production of various hormones including erythropoietin, parathyroid hormone-related protein, gonadotropins, ACTH-like substance, glucagon and insulin) .
Other manifestations of RCC may include:

Anemia (low blood counts) – quite common and can be severe.

Hepatic dysfunction – is uncommon

Fever, night sweats, anorexia, weight loss

Hypercalcemia (high serum calcium) – could be due to bone metastasis or due to systemic effects of various hormones.

Some patients also present with AA amyloidosis, thrombocytosis and polymyalgia rheumatica.

Diagnosis
The diagnostic evaluation is initiated by ordering CT abdomen or kidney ultrasound. Metastatic disease should be excluded after the presence of the renal mass is confirmed,

Treatment
Surgery is curative in the majority of patients without metastatic RCC.
Chemotherapy, immunotherapy and radiation therapy are offered for the metastatic disease.