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Clinical features

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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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