Renal Cell Carcinoma
RCC is increasingly a disease found by accident — a small renal mass picked up on a scan done for something else. The central question becomes: does this small mass even need treating, and if so, can we spare the kidney?
The big picture
RCC is increasingly a disease found by accident — a small renal mass picked up on a scan done for something else. That changes the central question from "how do we cure this" to "does this small mass even need treating, and if so, can we spare the kidney?" The modern themes are nephron-sparing (partial nephrectomy) wherever possible, active surveillance for small masses in the right patient, and a transformed systemic therapy landscape (TKIs + immunotherapy) for advanced disease.
The framework: know the subtypes → manage the small renal mass (partial nephrectomy / surveillance / ablation) → localised treatment by size → advanced disease (cytoreduction + TKI/immunotherapy).
Mechanism pathway
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Interactive — localized RCC management (cT1–cT2)
Diagnostic algorithm
Each step answers one question. Tap to expand.
Board traps
Clear cell is the commonest (~70%) and most IO/VEGF-responsive; papillary often multifocal; chromophobe most indolent.
Partial nephrectomy is the reference standard for the small renal mass (T1a) — spare the nephrons.
Active surveillance is valid for small masses in elderly/comorbid patients (many grow slowly/are benign).
RCC invades the renal vein/IVC (tumour thrombus) and is resistant to conventional chemo/RT.
Metastatic: IO doublet or IO + TKI first-line; cytoreductive nephrectomy in selected cases.
VHL → multiple bilateral early clear-cell RCC.