Education And Debate


BMJ 1996; 312 doi: (Published 04 May 1996) Cite this as: BMJ 1996;312:1146
  1. Chris Dawson,
  2. Hugh Whitfield

    Renal cell carcinoma

    Carcinoma of the renal parenchyma accounts for 3% of all cancers in adults and is seen twice as often in men as in women. Most cases occur in patients aged 50-70 years. No specific causative agents have yet been identified.

    Presentation of renal cell carcinoma

    • “Classic triad” (uncommon)

    • Pain or haematuria

    • Paraneoplastic syndromes

    • Symptoms of metastatic disease

    • Incidental finding


    Renal cell carcinoma notoriously presents in several ways. Although this tumour is believed to present typically with the “classic triad” (pain, haematuria, and a mass in the loin), this presentation occurs in only 10% of cases. Three quarters of patients present with either pain or haematuria.

    Ultrasound scan showing lower pole tumour of right kidney (arrow).

    Paraneoplastic syndromes are also common presentations—substances normally produced by the kidney (for example, prostaglandins, renin, and erythropoietin) may be produced in excess quantities, and other substances that the kidney does not usually secrete (such as parathyroid hormone-like chemicals, glucagon, and insulin) may be produced.

    Other presentations include the development of symptoms due to metastases (cachexia, fever, and night sweats). With the increased use of ultrasound scanning, more tumours are being discovered incidentally during investigations for non-urological complaints.


    When a renal mass is present clinically the initial investigation should be an ultrasound examination to determine whether the mass is renal in origin and whether it is cystic or solid. If the lesion is clearly seen in the ultrasound scan as a simple renal cyst then the patient usually needs no further follow up. Any cyst that cannot clearly be identified as a simple renal cyst should be further investigated with computed tomography.

    Cavagram showing extension of tumour thrombus into inferior vena cava (arrow).

    Solid renal masses should be investigated with computed tomography to gain information about the tumour, to see whether the tumour has …

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