Clinical features
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:
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