From the Guidelines
For a possible renal cancer lesion, you should consult a urologist as your primary specialist. Urologists are physicians who specialize in diseases of the urinary tract and male reproductive system, including kidney cancers. Your primary care physician can provide a referral to a urologist who will evaluate your symptoms, medical history, and any imaging studies you've had. The urologist may order additional tests such as CT scans, MRIs, or ultrasounds to better characterize the lesion, as recommended by the American Urological Association guideline 1. They might also recommend a biopsy to determine if the lesion is cancerous.
Depending on the findings, the urologist may collaborate with other specialists such as oncologists (cancer specialists) or nephrologists (kidney specialists) to develop a comprehensive treatment plan, as suggested by the American Society of Clinical Oncology clinical practice guideline 2. The urologist should lead the counseling process and consider all management strategies, including the importance of renal functional recovery and the potential risks of progressive chronic kidney disease (CKD) 3.
Early consultation is important as kidney cancer outcomes are generally better when detected and treated early. Don't delay seeking medical attention if you have symptoms like blood in urine, flank pain, or if a kidney lesion was incidentally found on imaging. The American Society of Clinical Oncology clinical practice guideline also emphasizes the importance of considering the patient's overall health, life expectancy, and preferences when making treatment decisions 4.
Some key considerations in the management of renal cancer lesions include:
- The role of renal mass biopsy in diagnosis and treatment planning 1
- The importance of individualized counseling and management, taking into account the patient's clinical, oncologic, and functional characteristics 3
- The potential benefits and risks of different treatment options, including partial nephrectomy, radical nephrectomy, thermal ablation, and active surveillance 2
- The need for multidisciplinary care and collaboration between urologists, oncologists, and nephrologists to ensure optimal outcomes for patients with renal cancer lesions 3, 4
From the Research
Diagnosis and Referral for Renal Cell Carcinoma
For a possible renal cell carcinoma (renal cancer) lesion, the following steps can be taken:
- Patients with a solid renal mass or complex cystic renal mass should be referred to urology 5
- Imaging studies such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can be used to characterize renal masses and differentiate between benign and malignant lesions 6, 7, 8
- In cases where ultrasound characterizes a renal lesion as solid, despite CT findings of a cystic lesion, kidney biopsies are recommended 7
Imaging Techniques
Different imaging techniques can be used to diagnose and stage renal cell carcinoma, including:
- Intravenous urography (IVU): often obtained as the first imaging study to evaluate the urinary tract in patients with symptoms that may indicate the presence of renal cell carcinoma 6
- Computed tomography (CT): the first choice for imaging of renal masses, and has been the mainstay for several decades 8
- Magnetic resonance imaging (MRI): considered as an important alternative in patients requiring further imaging or in cases of allergies, pregnancy, or surveillance 8
- Ultrasound: the most commonly used imaging technique for renal imaging in general, but may not always provide accurate characterization of renal masses 7, 8
Treatment Options
Treatment options for renal cell carcinoma include:
- Surgical resection: with partial or radical nephrectomy 9, 5
- Ablative techniques: such as cryoablation, radiofrequency ablation, and microwave ablation 9
- Active surveillance: for some patients, especially those with renal masses <2 cm 5
- Immune checkpoint inhibitors: and tyrosine kinase inhibitors: for patients with metastatic RCC 5