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Chapter 090. Bladder and Renal Cell Carcinomas (Part 6)

Clinical Presentation The presenting signs and symptoms include hematuria, abdominal pain, and a flank or abdominal mass. This classic triad occurs in 10–20% of patients. Other symptoms are fever, weight loss, anemia, and a varicocele (Table 90-4). The tumor can also be found incidentally on a radiograph. Widespread use of radiologic cross-sectional imaging procedures (CT, ultrasound, MRI) contributes to earlier detection, including incidental renal masses detected during evaluation for other medical conditions. The increasing number of incidentally discovered low-stage tumors has contributed to an improved 5-year survival for patients with renal cell carcinoma and increased use of nephron-sparing surgery (partial. | Chapter 090. Bladder and Renal Cell Carcinomas Part 6 Clinical Presentation The presenting signs and symptoms include hematuria abdominal pain and a flank or abdominal mass. This classic triad occurs in 10-20 of patients. Other symptoms are fever weight loss anemia and a varicocele Table 90-4 . The tumor can also be found incidentally on a radiograph. Widespread use of radiologic cross-sectional imaging procedures CT ultrasound MRI contributes to earlier detection including incidental renal masses detected during evaluation for other medical conditions. The increasing number of incidentally discovered low-stage tumors has contributed to an improved 5-year survival for patients with renal cell carcinoma and increased use of nephron-sparing surgery partial nephrectomy . A spectrum of paraneoplastic syndromes has been associated with these malignancies including erythrocytosis hypercalcemia nonmetastatic hepatic dysfunction Stauffer syndrome and acquired dysfibrinogenemia. Erythrocytosis is noted at presentation in only about 3 of patients. Anemia a sign of advanced disease is more common. Table 90-4 Signs and Symptoms in Patients with Renal Cell Cancer Presenting Sign or Symptom Incidence Classic triad hematuria flank pain flank mass 10-20 Hematuria 40 Flank pain 40 Palpable mass 25 Weight loss 33 Anemia 33 Fever 20 Hypertension 20 Abnormal liver function 15 Hypercalcemia 5 Erythrocytosis 3 N euromyopathy 3 Amyloidosis 2 Increased erythrocyte sedimentation rate 55 The standard evaluation of patients with suspected renal cell tumors includes a CT scan of the abdomen and pelvis chest radiograph urine analysis and urine cytology. If metastatic disease is suspected from the chest radiograph