Introduction

Kidney cancer, or renal cell carcinoma (RCC), is the tenth most common malignancy and the thirteenth leading cause of cancer death in the US. In 2001, there were predicted to be 30 800 new cases and 12 100 deaths due to kidney cancer, with an annual incidence that continues to increase. RCC is 2–3 times more common in men and tends to occur between the ages of 50–70 but can occur at any age. Smoking, obesity, diuretic use, and chronic renal dialysis have all been identified as risk factors. A small number of cases have a genetic basis with the most recognized association being the von Hippel–Lindau syndrome, an autosomal dominant disease which often causes multifocal, bilateral tumors. This chapter will review the presentation, prognosis, management, and outcome of patients with RCC.

Presentation

The presentation of RCC is variable; it may present as an incidental finding, with local or systemic symptoms, or with symptoms from metastatic disease. With radiographic investigations for other indications more frequent, an increasing number of asymptomatic kidney tumors are identified. Local symptoms may include hematuria, flank pain, or back pain. Systemic symptoms may include fatigue, weight loss, or anorexia. RCC, even if only localized disease is present, may also produce paraneoplastic syndromes such as erythrocytosis, hypercalcemia, elevated liver function tests, and fever. Symptoms specific to metastatic disease such as bone pain, cough, shortness of breath, or neurological symptoms may occur.