Renal cancer

Renal cancer is the seventh most common cancer in the UK and accounts for 4% of all new cancer diagnoses. The incidence of renal cancer is rising as a result of increased incidental diagnoses, an ageing population and higher prevalence of obesity. The classic presentation of renal cancer is as the triad of loin pain, a palpable loin mass and haematuria, but many cases of renal cancer do not present with clear symptoms. Late-stage diagnoses are common, necessitating more invasive treatments. Those suspected of having renal cancer should be referred and investigated without delay, with ultrasound and contrast computerised tomography being the best imaging modalities in most cases. Renal biopsies are not routinely necessary, although may be helpful in cases of diagnostic uncertainty such as lesions suspicious of metastatic deposits, benign tumours or to guide novel minimally invasive or oncological treatments. Between 80 and 90% of tumours are renal cell carcinomas, the vast majority of which are clear cell carcinomas, and only a small proportion of renal masses are completely benign. Surgery remains the key method of treatment in patients with local disease, with nephron sparing and radical methods being available depending on the disease stage. For patients with metastatic disease, the mainstay of treatment is oncological systemic therapies targeted at specific checkpoint markers.