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Renal Cell Carcinoma: Clinical Presentation, Staging, and Prognostic Factors

  • Chapter
Kidney Cancer

Abstract

Renal cell cancer (RCC) accounts for 2–3 % of adult malignancies, and the incidence appears to be rising each year. Initially the increasing prevalence of computed tomography (CT) imaging was thought to be the reason for the increased incidence as it led to incidental findings of renal masses. However, even between the years 2000 and 2009, the incidence of localized and distant disease has continued to increase. Cigarette smoking, obesity, end-stage renal failure, and hypertension are some of the contributing risk factors, although strong associations have not been established. Clear cell RCC is the most common histologic subtype and accounts for approximately 70 % of RCC. A minority (<5 %) of RCC cases are considered hereditary. The pathophysiology of majority of clear cell cancers is driven by structural alterations in the von Hippel-Lindau gene. Clinical presentation of the disease is frequently an asymptomatic, incidental finding of a renal mass. Only 9 % of kidney cancers present with the classic triad of hematuria, flank pain, and fever. About a third of the patients have advanced disease at diagnosis. RCC is known as one of the “great masqueraders,” due to the wide variety of paraneoplastic manifestations and up to 20 % of patients present with these. The imaging gold standard for the diagnosis, staging, and surveillance of RCC is the CT scan. Tumor stage and grade remain the most important prognostic factors in localized disease. Nomograms incorporating these have been developed to predict the risk of relapse. In metastatic disease, the Memorial Sloan-Kettering and Heng criteria have been adopted to predict overall survival outcomes. Development of predictive biomarkers, for therapy selection, is the current critical challenge in RCC. This chapter highlights the clinical presentations, staging, and prognostic factors associated with RCC.

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Authors and Affiliations

  1. Department of Internal Medicine, Wayne State University, Detroit, MI, USA

    Sri Bharathi Yadlapalli MD

  2. Department of Pathology, Wayne State University/Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA

    Dongping Shi MD

  3. Department of Oncology, Wayne State University/Barbara Ann Karmanos Cancer Institute, 4HWCRC 4100 John R, Detroit, MI, 48201, USA

    Ulka Vaishampayan MD

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  1. Sri Bharathi Yadlapalli MD
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Correspondence to Ulka Vaishampayan MD .

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  1. Department of Internal Medicine, Division of Hematology - Oncology, University of California Davis, School of Medicine UC Davis Comprehensive Cancer center, Sacramento, California, USA

    Primo N. Lara

  2. Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA

    Eric Jonasch

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Yadlapalli, S.B., Shi, D., Vaishampayan, U. (2015). Renal Cell Carcinoma: Clinical Presentation, Staging, and Prognostic Factors. In: Lara, P., Jonasch, E. (eds) Kidney Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-17903-2_7

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