Typically, twenty-five to thirty percent of patients are asymptomatic and the carcinoma is detected accidentally. Some of the symptoms that patients might complain about, although not common and usually indicative of advanced stages are:

• Hematuria
• Flank pain
• A palpable mass in the abdomen or flank
• Abdominal pain

Less common symptoms may include:

• Hypertension
• Weight loss
• Anemia
• Fever
• Malaise
• Back pain
• Pallor
• Vision problems

• Weight Loss

  Kidney cancer symptoms may include hematuria, back pain, and weight loss. Localized renal cell carcinoma is highly curable, and standard kidney cancer treatment is partial or radical nephrectomy. [medscape.org]

  I thought the weight loss was stress from the move. I was shocked when they said it was kidney cancer. I just want to be here to care for my family—I do everything for them.” [votrient.com]

  Most paraneoplastic signs and symptoms correlated with poor survival, although on multivariate analysis hypoalbuminemia, weight loss, anorexia and malaise predicted shorter survival. [ncbi.nlm.nih.gov]

• Fever

  A 58-year-old Chinese male presented with general fatigue and intermittent-remittent fever, accompanied by palpitations and dizziness. [ncbi.nlm.nih.gov]

  […] side effects of OPDIVO when used alone include: feeling tired; rash; pain in muscles, bones, and joints; itchy skin; diarrhea; nausea; weakness; cough; shortness of breath; constipation; decreased appetite; back pain; upper respiratory tract infection; fever [opdivo.com]

  […] symptoms that patients might complain about, although not common and usually indicative of advanced stages are: Hematuria Flank pain A palpable mass in the abdomen or flank Abdominal pain Less common symptoms may include: Hypertension Weight loss Anemia Fever [symptoma.com]

  It was not associated with fever, haematuria, but gives h/o loss of weight and loss of appetite. She was emaciated, poorly nourished with no significant past history. [omicsonline.org]

• Anemia

  The most common adverse effects were fatigue, diarrhea, hand-foot syndrome, skin discoloration and hematological alterations (leukopenia, anemia and thrombocytopenia) ( 6 ). [intjcancermanag.com]

  Of several adverse events, only anemia and fatigue were significantly more frequently observed in older than younger patients. [ncbi.nlm.nih.gov]

  Symptoms include blood in the urine, unexplained pain in the side or lower back, anemia, fever, and unexplained weight loss. [britannica.com]

  […] performance status (a measure of how well a person can do normal daily activities) The IMDC system includes: High white blood cell count (neutrophils) High platelet cell count High blood calcium level Anemia (low red blood cell count) Less than a year [cancer.org]

  In fact, the most common presenting sign of kidney cancer is a low red blood cell count ( anemia ). [cancer.about.com]

• Fatigue

  A 70-Year-Old African-American Woman with Metastatic RCC December 2017 A 70-year-old African-American woman presented to her PCP with loss of appetite, fatigue, abdominal pains, and blood in her stool CT of the chest, abdomen, & pelvis: distal esophageal [targetedonc.com]

  Where diarrhea was the dominant adverse event 61%, while hypertension 12% and fatigue 11% were the most frequent grade 3 non hematological toxicity. [intjcancermanag.com]

  A 58-year-old Chinese male presented with general fatigue and intermittent-remittent fever, accompanied by palpitations and dizziness. [ncbi.nlm.nih.gov]

• Malaise

  Cachexia did not predict a higher recurrence rate in patients with localized disease and only malaise correlated with a decreased likelihood of responding to immunotherapy. [ncbi.nlm.nih.gov]

  […] that patients might complain about, although not common and usually indicative of advanced stages are: Hematuria Flank pain A palpable mass in the abdomen or flank Abdominal pain Less common symptoms may include: Hypertension Weight loss Anemia Fever Malaise [symptoma.com]

  Other less frequent symptoms are anaemia, fever, nausea/vomiting, pallor, malaise and weight loss [3]. RCCs comprise a heterogeneous group of tumours. [eurorad.org]

  She visited Fukushima Medical University Aizu Medical Center Hospital with the chief complaints of weight-loss, pyrexia, and general malaise. The mass and tenderness were absent in abdomen. Clinical data had some abnormality. [journals.sagepub.com]

• Pleural Effusion

  Bilateral pleural effusion seen (Figures 3,4 and 5). FNAC (Fine needle aspiration cytology) shows round to polygonal cells having coarse chromatin. 2-4 nucleoli arranged in discreates. [omicsonline.org]

  The effusion was hemorrhagic, but was characterized as transudate. The pleural biopsy showed only an inflammatory pattern. [bjn.org.br]

  After three months of treatment, patient referred worsening dyspnea and a CT scan showed pulmonary progression with pleural effusion. [gavinpublishers.com]

  She was started on sunitinib postoperatively but failed therapy after developing bilateral malignant pleural effusion and malignant disease progression and was subsequently given temsirolimus. [hindawi.com]

  […] needle, should be performed when pleural effusion is present. [en.wikipedia.org]

• Nausea

  A 30-year-old Chinese woman was admitted to our Hospital, reporting headache, nasal congestion, nausea, vomiting, and a sharp decline in her right eye vision. [ncbi.nlm.nih.gov]

  Case presentation: A 49-year-old man, presented with ongoing severe heartburn, nausea and vomiting for 5 months. The patient further complained of weight loss over the last 2 months. [dovepress.com]

  Other less frequent symptoms are anaemia, fever, nausea/vomiting, pallor, malaise and weight loss [3]. RCCs comprise a heterogeneous group of tumours. [eurorad.org]

  The most common side effects of OPDIVO when used alone include: feeling tired; rash; pain in muscles, bones, and joints; itchy skin; diarrhea; nausea; weakness; cough; shortness of breath; constipation; decreased appetite; back pain; upper respiratory [opdivo.com]

  Side effects can include fatigue, nausea, and vomiting. Complementary treatments may include taking certain vitamins alongside regular treatment. This should first be discussed with a physician. [medicalnewstoday.com]

• Abdominal Mass

  Conclusion: The classical triad of loin pain, hematuria and abdominal mass for RCC is not that common and RCC should be suspected in patients complaining of upper GI pain with nonspecific symptoms. [dovepress.com]

  Mostly asymptomatic; classic triad of abdominal mass, flan pain and hematuria detected in only ~1/3 of patients. [auanet.org]

  The most common symptoms are flank or abdominal pain, gross haematuria, and an abdominal mass. Other less frequent symptoms are anaemia, fever, nausea/vomiting, pallor, malaise and weight loss [3]. RCCs comprise a heterogeneous group of tumours. [eurorad.org]

  The symptoms of RCC may include, but are not limited to: 3 Blood in urine Pain in side Abdominal mass Fatigue and loss of appetite Weight loss Early diagnosis of RCC is crucial Like all forms of cancer, the stage at which an RCC diagnosis is made has [roche.com]

  Clinical Presentation • Most asymptomatic • Hematuria present 40% of patients • Classic triad: flank pain, hematuria, palpable abdominal mass occur in 9% of patients • 45% present with localized disease, • 25% with locally advanced disease, • 30% with [slideshare.net]

• Abdominal Pain

  A 70-Year-Old African-American Woman with Metastatic RCC December 2017 A 70-year-old African-American woman presented to her PCP with loss of appetite, fatigue, abdominal pains, and blood in her stool CT of the chest, abdomen, & pelvis: distal esophageal [targetedonc.com]

  Other symptoms, such as backache or abdominal pain tend to be non-specific. As a result, RCC is often discovered by chance during routine imaging examinations for unrelated complaints. [pharma.bayer.com]

  A 56-year-old female with past medical history of thrombotic microangiopathy presented to her physician with nonspecific abdominal pain. [ncbi.nlm.nih.gov]

  Some of the symptoms that patients might complain about, although not common and usually indicative of advanced stages are: Hematuria Flank pain A palpable mass in the abdomen or flank Abdominal pain Less common symptoms may include: Hypertension Weight [symptoma.com]

  Clinical History This is a case of a 13-year-old female patient with flank pain and abdominal distention. [eurorad.org]

• Left Flank Pain

  This case has presented at first to urologist with complaint of left flank pain and in her ultrasound evaluation has detected a single renal mass. She has not shown any history of malignancy in her family. Past history about drug was negative. [intjcancermanag.com]

  The patient denied any changes in bowel habits or urinary complaints other than intermittent left flank pain. The patient reported that her family history was negative for cancer or polyps. [hindawi.com]

• Right Flank Pain

  Introduction A 70 year-old man presents with a history of gross hematuria, gross passage of clots, abdominal distention and right flank pain. He has a history of coronary artery disease with a myocardial infarction about 20 years ago. [ispub.com]

• Hypertension

  Age, male gender, body mass index, diabetes, and hypertension were all significant associated with renal cancer in bivariate analysis (P CONCLUSIONS: Obesity, hypertension, and smoking are the 3 modifiable risk factors that could aggressively be targeted [ncbi.nlm.nih.gov]

  Role of diuretics, other anti-hypertensive medications and hypertension. Int J Cancer. 1995;63(2):216–21. PubMed CrossRef Google Scholar 82. Choi MY, Jee SH, Sull JW, Nam CM. The effect of hypertension on the risk for kidney cancer in Korean men. [doi.org]

• Tachycardia

  At admission she had hypotension, tachycardia, and was febrile. [elsevier.es]

  A case report of polymorphic ventricular tachycardia/ventricular fibrillation induced by herbal medication used for obesity. Int J Cardiol 2006;106:260-1. View abstract. Baba M, Snoeck R, Pauwels R, de Clercq E. [rxlist.com]

  A case report of polymorphic ventricular tachycardia/ventricular fibrillation induced by herbal medication used for obesity. Int J Cardiol 2006;106:260-1. View abstract. Okamura K, Inoue K, Omae T. [medlineplus.gov]

• Back Pain

  Kidney cancer symptoms may include hematuria, back pain, and weight loss. Localized renal cell carcinoma is highly curable, and standard kidney cancer treatment is partial or radical nephrectomy. [medscape.org]

  MEDICAL HISTORY: Presented with rapid weight loss and lower back pain INITIAL DIAGNOSIS: Metastatic renal cell carcinoma (RCC) with a clear cell histology; scheduled for laparoscopic nephrectomy CURRENT STATUS: RCC is metastatic and Fernando is treatment [votrient.com]

  A 86-year-old man with a chief complaint of continuous back pain for 3 months and discovery of a cutaneous nodule on the nose for a month visited the oncology department of our hospital. [ncbi.nlm.nih.gov]

  […] loss Anemia Fever Malaise Back pain Pallor Vision problems Renal cell carcinoma is a challenging and unique tumor because of the occurrence of paraneoplastic syndromes. [symptoma.com]

  On presentation, it was learned that about one year ago, renal cell carcinoma was diagnosed after the complaints of back pain and hematuria. [cureus.com]

• Hematuria

  Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. [ncbi.nlm.nih.gov]

  Kidney cancer symptoms may include hematuria, back pain, and weight loss. Localized renal cell carcinoma is highly curable, and standard kidney cancer treatment is partial or radical nephrectomy. [medscape.org]

  Conclusion: The classical triad of loin pain, hematuria and abdominal mass for RCC is not that common and RCC should be suspected in patients complaining of upper GI pain with nonspecific symptoms. [dovepress.com]

  The most common form of presentation of RCC in children is macroscopic hematuria and abdominal or flank pain. Other less frequent symptoms are palpable abdominal mass, anaemia, and fever [ 2, 5 ]. [panafrican-med-journal.com]

• Flank Pain

  Some of the symptoms that patients might complain about, although not common and usually indicative of advanced stages are: Hematuria Flank pain A palpable mass in the abdomen or flank Abdominal pain Less common symptoms may include: Hypertension Weight [symptoma.com]

  Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. [ncbi.nlm.nih.gov]

  Indicators of symptomatic presentations include flank pain, flank mass, varicocele, constitutional symptoms, paraneoplastic syndromes and bone pain related to metastatic disease [ 7 ]. [jmedicalcasereports.biomedcentral.com]

  Now the patient presents with dull R flank pain. [cancertherapyadvisor.com]

  RCC may not be diagnosed until after it has metastasized because the primary tumor can grow fairly large without creating symptoms such as flank pain or a mass in the abdomen. [urotoday.com]

• Macroscopic Hematuria

  They usually occur in 50-70-year old patients and macroscopic hematuria occurs in 60% of the cases. [radiopaedia.org]

  The most common form of presentation of RCC in children is macroscopic hematuria and abdominal or flank pain. Other less frequent symptoms are palpable abdominal mass, anaemia, and fever [ 2, 5 ]. [panafrican-med-journal.com]

  Urinalysis - micro- or macroscopic hematuria occurs in 60% of patients Complete blood count (CBC) - patients may have anemia of chronic inflammation (normo- or microcytic), some have erythrocytosis from paraneoplastic erythropoietin (Epo) production, [clinicaladvisor.com]

  Although it is strange, microscopic or macroscopic hematuria and proteinuria were absent. Esophagogastroduodenoscopy revealed a subepithelial lesion with a 10-mm central umbilication in the gastric greater curvature. [journals.sagepub.com]

• Peripheral Neuropathy

  Patients with irreversible toxicity that is not reasonably expected to be exacerbated by the IMP may be included e.g. hearing loss, peripheral neuropathy etc. [clinicaltrials.gov]

Renal cell carcinoma is a challenging and unique tumor because of the occurrence of paraneoplastic syndromes. The workup for RCC should also include laboratory tests for these paraneoplastic syndromes [5].

The use of imaging modalities is helpful in the evaluation of the renal mass. These include:

• Computed tomography
• Ultrasoundography
• Venography
• Arteriography
• Magnetic resonance imaging
• Positron-emission tomography [5]

Differentiating a non-malignant and malignant renal mass can be difficult. Typically, when a patient presents for a physical examination for possible RCC it is most likely in the metastatic stage. The physical exam should pay close attention to the:

• Lungs
• Bones
• Liver
• Soft tissue
• Central nervous system
• Cutaneous sites

Some of the laboratory testing should include, but not limited to:

• Urinalysis
• Complete blood count (CBC)
• Liver function test
• Renal profile
• Chemistry profile (electrolytes) with serum calcium

• Abnormal Renal Function

  In view of this, pazopanib appears to represent an alternative for this patient group, as well as individuals with a recent ( Impaired renal function Abnormal renal function is frequently noted in patients with advanced RCC. [cancertherapyadvisor.com]

• Pleural Effusion

  Bilateral pleural effusion seen (Figures 3,4 and 5). FNAC (Fine needle aspiration cytology) shows round to polygonal cells having coarse chromatin. 2-4 nucleoli arranged in discreates. [omicsonline.org]

  The effusion was hemorrhagic, but was characterized as transudate. The pleural biopsy showed only an inflammatory pattern. [bjn.org.br]

  After three months of treatment, patient referred worsening dyspnea and a CT scan showed pulmonary progression with pleural effusion. [gavinpublishers.com]

  She was started on sunitinib postoperatively but failed therapy after developing bilateral malignant pleural effusion and malignant disease progression and was subsequently given temsirolimus. [hindawi.com]

  […] needle, should be performed when pleural effusion is present. [en.wikipedia.org]

More than 50% of patients who are diagnosed with RCC in the early stages are cured. The approach of treatment is determined by the size and stage of the tumor. The primary care physician should review the patient’s current health status, renal function, oncologic issues and complication risks [5].

The main treatments available for renal cell carcinoma are:

• Surgery: Surgical resection is the only effective treatment for a localized tumor, but has also been used for metastatic disease as a palliative therapy.
• Immunotherapy: Used as a standard of care in metastatic disease.
• Radiation therapy: Used as a standard of care in metastatic disease as a palliative therapy for patients who clinically are not surgical candidates.
• Molecular-targeted therapy: Used as a standard of care in metastatic disease

Experimental therapies include:

• Nonmyeloablative allogeneic peripheral stem-cell transplantation
• Interferon
• Interleukin-2
• Tumor infiltrating lymphocytes

There are studies available for those patients who may qualify. One such study ARGOS, ADAPT Phase 3, is a worldwide randomized study to examine their product to extend the survival rate of early diagnosed renal cell carcinoma patients [8].

RCC is the tenth leading cause of death in males. The rate of complications, transfusions, and in-hospital mortality is higher in patients treated with cytoreductive nephrectomy than in those who underwent nephrectomy. Risk is further increased in patients who are older, have higher comorbidity, or need secondary surgical procedures. A study by Heng et al found that progression-free survival at 3 and 6 months predicted overall survival among patients with metastatic renal cell carcinoma. The survival rate depends on if the cancer has already metastasized outside of the kidney and how well the patient tolerates the course of treatment. If RCC is diagnosed in the early stages the prognosis is good.

The following are factors associated with increased survival in patients with metastatic disease:

• A long disease-free interval between initial nephrectomy and the appearance of metastases
• The presence of only pulmonary metastases
• Good performance status
• Removal of the primary tumor

The exact cause of RCC is unclear at this time. It is known that many predisposing factors play a major role in the causation of RCC. Cigarette smoking, obesity, occupational exposure to chemicals, chronic use of NSAIDS, and few genetic disorders are the major causative factors.

Incidence

Renal cell carcinoma varies widely globally with the highest rates being in the North America and the Czech Republic [2]. In the United States alone, there are 64,000 new cases and approximately 14,000 deaths per year [3]. RCC is the seventh most common cancer in males. Statistics show that 50% of those with RCC die within 5 years after diagnosis [3] [4].

Gender and age

Renal cell carcinoma is 50% more prevalent in males than females. RCC most often occurs between 60 to 80 years of age with the median age being 64 [5].

The origin of renal cell carcinoma is in the proximal renal tubular epithelium. There are four hereditary syndromes that are associated with renal cell carcinoma [7]:

• Von Hippel-Lindau disease (VHL)
• Hereditary papillary renal carcinoma (HPRC)
• Hereditary renal carcinoma (HRC)
• Familial renal oncocytoma associated with Birt-Hogg-Dube syndrome (BHDS)

Although there are no set prevention methods, avoiding causative factors can be helpful. Some of these factors include smoking, obesity, occupational and environmental exposures to toxic chemicals. Patients with acquired renal cystic disease undergoing long term dialysis or renal transplant, and patients with chronic hepatitis C should take precautions and report unusual symptoms such as blood in the urine, pain on urination or any of the other mentioned symptoms.

Renal cell carcinoma (RCC) is accountable for 80-85 percent of all primary renal neoplasms. There may be multiple tumors in one kidney or there could be tumors in both kidneys. This type of renal cancer is seen most frequently. There are several histologic subtypes of RCC. Knowing the type of cell will decide the type of treatment. It is also helpful to determine if it is an inherited genetic syndrome.

The subtypes are [1] [9]:

• Clear cell: The most common type of RCC (83%)
• Papillary (11%)
• Chromophobic (4%)
• Collecting duct

Definition

Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults accounting for 95% of renal tumors.

Cause

Cigarette smoking, obesity, occupational exposure to chemicals, chronic use of NSAIDS, and few genetic disorders are the most common causative factors.

Symptoms

Patients at risk should be precautious and report unusual symptoms such as blood in the urine, flank pain or a palpable mass in the abdomen or flank. 

Diagnosis

Diagnosis is generally by combination of physical examination, Laboratory tests and Imaging. Imaging forms an important part to know the spread, and to plan the treatment.

Treatment

Most of the early cases are cured. The treatment varies depending on the stage of the disease.

1. Cheville JC, Lohse CM, Zincke H, Weaver AL, Blute ML. Comparisons of outcomes and prognostic features among histologic subtypes of renal cell carcinoma.Am J Surg Pathol, 2003 May;27(5):612-24 
2. Chow WH, Dong LM, Devesa SS. Epidemiology and risk factors for kidney cancer. Nat Rev Urol 2010; 7:245
3. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64:9
4. P. Lindblad. Department of Urology, Sundsvall Hospital, Sundsvall, Sweden. Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society
5. Schmidinger M, Vogl UM, Bojic M, Lamm W, Heinzl H, Haitel A, et al. Hypothyroidism in patients with renal cell carcinoma: blessing or curse?. Cancer. Feb 1 2011;117(3):534-44
6. Renal Cell Carcinoma Author: Kush Sachdeva, MD; Chief Editor: Jules nlm.nih.gov/medlineplus/ency/article/000516.htm 
7. Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
8. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011; 61:212.