Renal Cell Carcinoma Differential Diagnoses

  • Author: Brendan Curti, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Mar 2, 2012
 
 

Diagnostic Considerations

In 25-30% of patients, renal cell carcinoma (RCC) is asymptomatic and found incidentally on a radiologic study. A renal mass of indeterminate etiology should be monitored periodically by imaging study such as intravenous pyelography (IVP), ultrasonography, or computed tomography (CT) scanning.

A cystic mass can be simply observed; however, patients with a solid mass should have a complete workup, including evaluation for metastatic disease and vascular extension of the primary tumor. In fact, as many as one third of patients with clinically localized disease may develop metastatic disease after nephrectomy, so they should be monitored carefully. The major medical pitfall is ignoring a solid renal mass and failing to provide appropriate follow-up care.

Excruciating, sharp, bandlike back pain may be an early warning for spinal cord compression due to metastatic renal cell carcinoma and should not be ignored. Urgent magnetic resonance imaging should be performed to rule out cord compression, and high-dose dexamethasone therapy should be started.

Go to Clear Cell Renal Cell Carcinoma and Sarcomatoid and Rhabdoid Renal Cell Carcinoma for complete information on these topics.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Brendan Curti, MD  Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center

Brendan Curti, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, Oregon Medical Association, and Society for Biological Therapy

Disclosure: Nothing to disclose.

Coauthor(s)

Bagi RP Jana, MD  Assistant Professor, University of Texas Medical Branch, Galveston, TX

Bagi RP Jana, MD is a member of the following medical societies: American Cancer Society, American Medical Association, American Society of Clinical Oncology, and Southwest Oncology Group

Disclosure: Nothing to disclose.

Mansoor Javeed, MD, FACP  Clinical Assistant Professor of Medicine, University of California, Davis, School of Medicine; Consultant, Sierra Hematology-Oncology Medical Center

Mansoor Javeed, MD, FACP is a member of the following medical societies: American College of Physicians and Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Issam Makhoul, MD  Associate Professor, Department of Medicine, Division of Hematology/Oncology, University of Arkansas for Medical Sciences

Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology and American Society of Hematology

Disclosure: Nothing to disclose.

Kush Sachdeva, MD  Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Wendy Hu, MD  Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center

Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

  1. Jonasch et al. In: Kantarjian HM, Wolff RA, Koller CA, eds. Renal cell carcinoma. MD Anderson Manual of Medical Oncology. New York, NY: McGraw-Hill; 2006.

  2. Linehan MW, Berton Z, Bates S. In: Devita VT Jr, Hellman S, Rosenberg SA, eds. Cancer of kidney and ureter. Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:1362-96.

  3. Simon JW, Marshall FF. In: Abeloff MD, Armitage J, Niederhuber J, Kastan M, McKenna W, eds. Kidney and ureter. Clinical Oncology. 2nd ed. New York, NY: Churchill Livingstone; 2000:1784-99.

  4. Cho E, Curhan G, Hankinson SE, et al. Prospective evaluation of analgesic use and risk of renal cell cancer. Arch Intern Med. Sep 12 2011;171(16):1487-93. [Medline].

  5. Surveillance Epidemiology and End Results. SEER Stat Fact Sheets. National Cancer Institute. Available at http://seer.cancer.gov/statfacts/html/kidrp.html. Accessed February 2, 2010.

  6. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. Jul-Aug 2009;59(4):225-49. [Medline].

  7. Levi F, Ferlay J, Galeone C, Lucchini F, Negri E, Boyle P, et al. The changing pattern of kidney cancer incidence and mortality in Europe. BJU Int. Apr 2008;101(8):949-58. [Medline].

  8. Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. Mar 1969;101(3):297-301. [Medline].

  9. Robson JS. Advances in the treatment of renal disease. Practitioner. Oct 1969;203(216):483-93. [Medline].

  10. Abdollah F, Sun M, Thuret R, et al. Mortality and morbidity after cytoreductive nephrectomy for metastatic renal cell carcinoma: a population-based study. Ann Surg Oncol. Oct 2011;18(10):2988-96. [Medline].

  11. Heng DY, Xie W, Bjarnason GA, et al. Progression-free survival as a predictor of overall survival in metastatic renal cell carcinoma treated with contemporary targeted therapy. Cancer. Nov 18 2010;[Medline].

  12. Motzer RJ, Mazumdar M, Bacik J, Berg W, Amsterdam A, Ferrara J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. Aug 1999;17(8):2530-40. [Medline].

  13. Zisman A, Pantuck AJ, Wieder J, Chao DH, Dorey F, Said JW, et al. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol. Dec 1 2002;20(23):4559-66. [Medline].

  14. [Guideline] Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. Oct 2009;182(4):1271-9. [Medline]. [Full Text].

  15. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Kidney Cancer [serial online]. 2011;v.2:Accessed May 21 2011. Available at http://www.nccn.org/professionals/physician_gls/pdf/kidney.pdf.

  16. Sauk SC, Hsu MS, Margolis DJ, et al. Clear cell renal cell carcinoma: multiphasic multidetector CT imaging features help predict genetic karyotypes. Radiology. Dec 2011;261(3):854-62. [Medline].

  17. Alt AL, Boorjian SA, Lohse CM, Costello BA, Leibovich BC, Blute ML. Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer. Jan 10 2011;[Medline].

  18. Haramis G, Mues AC, Rosales JC, et al. Natural history of renal cortical neoplasms during active surveillance with follow-up longer than 5 years. Urology. Apr 2011;77(4):787-91. [Medline].

  19. Alt AL, Boorjian SA, Lohse CM, et al. Survival after complete surgical resection of multiple metastases from renal cell carcinoma. Cancer. Jul 1 2011;117(13):2873-82. [Medline].

  20. Zagoria RJ, Pettus JA, Rogers M, et al. Long-term outcomes after percutaneous radiofrequency ablation for renal cell carcinoma. Urology. Jun 2011;77(6):1393-7. [Medline].

  21. Sunitinib or sorafenib in treating patients with kidney cancer that was removed by surgery. Available at http://clinicaltrials.gov/ct2/show/NCT00326898. Accessed December 6, 2010.

  22. Verma J, Jonasch E, Allen P, Tannir N, Mahajan A. Impact of tyrosine kinase inhibitors on the incidence of brain metastasis in metastatic renal cell carcinoma. Cancer. Nov 1 2011;117(21):4958-65. [Medline].

  23. Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Staehler M, et al. Sorafenib for treatment of renal cell carcinoma: Final efficacy and safety results of the phase III treatment approaches in renal cancer global evaluation trial. J Clin Oncol. Jul 10 2009;27(20):3312-8. [Medline].

  24. Escudier B, Eisen T, Stadler WM, Szczylik C, Oudard S, Siebels M, et al. Sorafenib in advanced clear-cell renal-cell carcinoma. N Engl J Med. Jan 11 2007;356(2):125-34. [Medline].

  25. Wu S, Chen JJ, Kudelka A, Lu J, Zhu X. Incidence and risk of hypertension with sorafenib in patients with cancer: a systematic review and meta-analysis. Lancet Oncol. Feb 2008;9(2):117-23. [Medline].

  26. Schmidinger M, Vogl UM, Bojic M, Lamm W, Heinzl H, Haitel A, et al. Hypothyroidism in patients with renal cell carcinoma: blessing or curse?. Cancer. Feb 1 2011;117(3):534-44. [Medline].

  27. Stadler WM, Figlin RA, McDermott DF, Dutcher JP, Knox JJ, Miller WH Jr, et al. Safety and efficacy results of the advanced renal cell carcinoma sorafenib expanded access program in North America. Cancer. Mar 1 2010;116(5):1272-80. [Medline].

  28. Motzer RJ, Michaelson MD, Redman BG, Hudes GR, Wilding G, Figlin RA, et al. Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol. Jan 1 2006;24(1):16-24. [Medline].

  29. Sutent (sunitinib malate) [package insert]. New York, NY: Pfizer Labs; 2010. Available at http://www.pfizer.com/files/products/uspi_sutent.pdf. Accessed December 6, 2010.

  30. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Rixe O, et al. Sunitinib versus interferon alfa in metastatic renal-cell carcinoma. N Engl J Med. Jan 11 2007;356(2):115-24. [Medline].

  31. Motzer RJ, Hutson TE, Tomczak P, Michaelson MD, Bukowski RM, Oudard S, et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol. Aug 1 2009;27(22):3584-90. [Medline].

  32. Gore ME, Szczylik C, Porta C, Bracarda S, Bjarnason GA, Oudard S, et al. Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: an expanded-access trial. Lancet Oncol. Aug 2009;10(8):757-63. [Medline].

  33. Rini BI, Cohen DP, Lu DR, et al. Hypertension as a biomarker of efficacy in patients with metastatic renal cell carcinoma treated with sunitinib. J Natl Cancer Inst. May 4 2011;103(9):763-73. [Medline]. [Full Text].

  34. Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. May 31 2007;356(22):2271-81. [Medline].

  35. Motzer RJ, Hudes GR, Curti BD, McDermott DF, Escudier BJ, Negrier S, et al. Phase I/II trial of temsirolimus combined with interferon alfa for advanced renal cell carcinoma. J Clin Oncol. Sep 1 2007;25(25):3958-64. [Medline].

  36. Afinitor (everolimus) [package insert]. East Hanover, NJ: Novartis Pharmaceuticals; 2009. Available at http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022334lbl.pdf. Accessed December 6, 2010.

  37. Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma : final results and analysis of prognostic factors. Cancer. Sep 15 2010;116(18):4256-65. [Medline].

  38. Motzer RJ, Escudier B, Oudard S, Hutson TE, Porta C, Bracarda S, et al. Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet. Aug 9 2008;372(9637):449-56. [Medline].

  39. Escudier B, Pluzanska A, Koralewski P, Ravaud A, Bracarda S, Szczylik C, et al. Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet. Dec 22 2007;370(9605):2103-11. [Medline].

  40. [Best Evidence] Escudier B, Bellmunt J, Négrier S, Bajetta E, Melichar B, Bracarda S, et al. Phase III trial of bevacizumab plus interferon alfa-2a in patients with metastatic renal cell carcinoma (AVOREN): final analysis of overall survival. J Clin Oncol. May 1 2010;28(13):2144-50. [Medline].

  41. US Food and Drug Administration. Bevacizumab (Avastin) in Combination with Interferon Alfa. Available at http://www.fda.gov/AboutFDA/CentersOffices/CDER/ucm176025.htm. Accessed December 7, 2010.

  42. Rini BI, Escudier B, Tomczak P, Kaprin A, Szczylik C, Hutson TE, et al. Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet. Dec 3 2011;378(9807):1931-9. [Medline].

  43. Rini BI, Escudier B, Tomczak P, et al. Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): a randomised phase 3 trial. Lancet. Dec 3 2011;378(9807):1931-9. [Medline].

  44. Ravaud A, Hawkins R, Gardner JP, von der Maase H, Zantl N, Harper P, et al. Lapatinib versus hormone therapy in patients with advanced renal cell carcinoma: a randomized phase III clinical trial. J Clin Oncol. May 10 2008;26(14):2285-91. [Medline].

  45. Rini BI, Vogelzang NJ, Dumas MC, Wade JL 3rd, Taber DA, Stadler WM. Phase II trial of weekly intravenous gemcitabine with continuous infusion fluorouracil in patients with metastatic renal cell cancer. J Clin Oncol. Jun 2000;18(12):2419-26. [Medline].

  46. Law TM, Motzer RJ, Mazumdar M, Sell KW, Walther PJ, O'Connell M, et al. Phase III randomized trial of interleukin-2 with or without lymphokine-activated killer cells in the treatment of patients with advanced renal cell carcinoma. Cancer. Sep 1 1995;76(5):824-32. [Medline].

  47. Choueiri TK, Dreicer R, Rini BI, Elson P, Garcia JA, Thakkar SG, et al. Phase II study of lenalidomide in patients with metastatic renal cell carcinoma. Cancer. Dec 1 2006;107(11):2609-16. [Medline].

  48. Patel PH, Kondagunta GV, Schwartz L, Ishill N, Bacik J, DeLuca J, et al. Phase II trial of lenalidomide in patients with metastatic renal cell carcinoma. Invest New Drugs. Jun 2008;26(3):273-6. [Medline].

  49. Rahma OE, Ashtar E, Ibrahim R, Toubaji A, Gause B, Herrin VE, et al. A pilot clinical trial testing mutant von Hippel-Lindau peptide as a novel immune therapy in metastatic renal cell carcinoma. J Transl Med. Jan 28 2010;8:8. [Medline]. [Full Text].

  50. Childs R, Chernoff A, Contentin N, Bahceci E, Schrump D, Leitman S, et al. Regression of metastatic renal-cell carcinoma after nonmyeloablative allogeneic peripheral-blood stem-cell transplantation. N Engl J Med. Sep 14 2000;343(11):750-8. [Medline].

  51. Mukund A, Gamanagatti S. Ethanol ablation of renal cell carcinoma for palliation of symptoms in advanced disease. J Palliat Med. Feb 2010;13(2):117-20. [Medline].

  52. NCI drug dictionary: pazopanib hydrochloride. National Cancer Institute. Available at http://www.cancer.gov/drugdictionary/?CdrID=476479. Accessed December 6, 2010.

 
Previous
Next
 
Table. Pathologic Classification of Renal Cell Carcinoma
Cell TypeFeaturesGrowth PatternCell of OriginCytogenetics
Clear cellMost commonAcinar or sarcomatoidProximal tubule3p-
ChromophilicBilateral and multifocalPapillary or sarcomatoidProximal tubule+7, +17, -Y
ChromophobicIndolent courseSolid, tubular, or sarcomatoidCortical collecting ductHypodiploid
OncocyticRarely metastasizeTumor nestsCortical collecting ductUndetermined
Collecting ductVery aggressivePapillary or sarcomatoidMedullary collecting ductUndetermined
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.