Management of localised renal cell cancer

Abstract

Renal cell cancer (RCC) is common, and its incidence is increasing due to increasing exposure to risk factors which include tobacco use, hypertension and obesity. Localised renal cancers are often detected incidentally, and their increased incidence also results from the increased use of imaging. Localised renal cancer now accounts for 60-70% of new RCC cases. Many of these cancers are slow growing and show little tendency to metastasize. Only a minority of patients with localised renal cell cancer have any clinical signs such as haematuria or abdominal pain. These tumours are often detected incidentally on ultrasound but are best characterised using computed tomography (CT), where they may appear as a solid contrast-enhancing mass or a complex cystic lesion. Imaging features are similar on Magnetic Resonance Imaging (MRI) and the latter is equally accurate for the evaluation of renal lesions; it may be used in patients who are allergic to iodinated contrast material, in those with poor renal function, in lesions containing complex haemorrhage or where radiation exposure must be avoided (e.g. pregnancy).