clinical features

Last reviewed 03/2023

The tumour is often clinically silent until it is locally very advanced. More than 50% of RCC’s are detected during non-invasive imaging used to investigate various nonspecific symptoms and other abdominal diseases (1)

Classically, patients present with the triad of (the complete triad of features is present in 6-10% of cases)

• haematuria in 60% - may be frank or microscopic, and may produce an iron deficiency anaemia.
• flank pain in 40%
• palpable flank mass in 25%

Metastases are found in 25-40% of patients at presentation and these patients may present with bone pain, persistent cough, upper GI bleed, and neurologic deficits (1,2)

Local extension into the left renal vein may result in a varicocoele whilst extension into the inferior vena cava produces the typical signs of IVC obstruction - bilateral leg oedema and collateral venous circulation.

A number of paraneoplastic syndromes may occur and are found in approximately 30% of patients with symptomatic RCCs including:

• polycythaemia - secretion of erythropoietin
• hypercalcaemia - secretion of PTH related peptide
• hypertension - secretion of renin
• neuromyopathy
• feminising / masculinising syndromes

Reference:

• (1) Ljungberg B et al. EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol. 2015;67(5):913-24. 
• (2) Chittoria B, Rini BI. Renal cell carcinoma. Cleveland clinic, Center for continuing education 2013