RENAL TUMORS

I. Pathophysiology/Epidemiology

1. Fairly uncommon; us. present middle-age or later
2. No known hereditary predisposition
3. Exposure to aniline dyes is a risk factor; possible HTN is also

II. Most present with vague systemic complaints

1. <10% present with classical triad: pain, mass, hematuria
2. Other presentations:

1. Hormonal abnlties, e.g. calcitonin, EPO
2. Hepatic dysfn with elevated LFTs in 20% of pts

III. Workup: US, CT if suspicious US

IV. Treatment: generally surgery

Renal masses incidentally discovered on abdominal imaging: In a study in 349 such masses removed surgically, 83% were renal cell carcinomata; high-grade histology was seen in 7%, 29%, and 52% in the masses measuring < 2cm, 2-4cm, and > 4cm, respectively (J. Urol. 176:1317, 2006--JW).  Treatment options for small tumors include RF ablation or cryoablation (both can be done laparoscopically or percutaneously).