title: Evaluation and management of the renal mass.
abstract: The evaluation and management of renal cell carcinoma (RCC) has evolved in recent decades in response to the changing clinical presentation of the disease. Traditional teaching suggested that RCC usually presents with signs or symptoms. However, RCC discovered this way was usually locally advanced and often metastatic, requiring radical nephrectomy in most cases but often having a poor prognosis. As contemporary general medical practice began routinely using axial body imaging in the evaluation of many nonspecific abdominal complaints, today more than 70% of RCC cases identified are "screen-detected" as incidental findings having no attributable symptoms. This change has prompted a significant RCC stage migration over the past 20 years, with most kidney tumors seen in 2010 being smaller, organ-confined, and appropriate for nephron-sparing approaches with the anticipation of a favorable outcome. The approach to addressing patients with these incidentally detected, often localized, small renal masses raises different concerns than those for traditional patients presenting with symptomatic RCC. This article reviews the modern epidemiology of RCC, outlines the components of the evaluation of the incidental renal mass, details the current options of management, and discusses the long-term expectations for these patients.
authors.affiliation: Department of Surgery, Fox Chase Cancer Center, Temple University School of Medicine, 333 Cottman Avenue, Philadelphia, PA 19111, USA. david.chen@fccc.edu
authors.forename: David Y T
authors.initials: DY
authors.lastname: Chen
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
mesh_terms: D000367:Age Factors; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D011320:Primary Health Care; D044469:Racial Groups; D012737:Sex Factors; D013520:Urologic Surgical Procedures / Q000379:methods