Renal cell carcinoma is the most common kidney cancer in adults and starts in the lining of the kidney tubules. Smoking, obesity and high blood pressure raise the risk, and many tumors are now found by chance on imaging before they cause symptoms.
Key symptoms
- Blood in the urine
- Flank pain
- Weight loss, fever or night sweats
- Often no symptoms; found on imaging
- Bone pain or cough from spread
What you find on exam
- Palpable flank or abdominal mass
- Left-sided varicocele that does not go away when lying down
- Leg swelling from vein involvement
- High blood pressure
Tests
- Urinalysis for blood
- CT of the abdomen and pelvis with contrast: enhancing solid kidney mass
- Chest imaging for staging
- Blood count, calcium, liver and kidney tests (anemia, polycythemia, high calcium)
Treatment basics
- Partial or radical nephrectomy for localized disease
- Active surveillance or ablation for small masses in selected patients
- Immunotherapy and targeted drugs, such as pembrolizumab with axitinib, for advanced disease
- Smoking cessation and follow-up that protects kidney function
Red flags
- Visible blood in the urine in an adult
- New left varicocele in an older man
- Weight loss with a flank mass
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.