Renal Parenchymal Neoplasms
The story of renal cell carcinoma has changed: it used to present late with a dramatic triad, but today most are found incidentally on imaging done for something else.
The big picture
The story of renal cell carcinoma has changed: it used to present late with a dramatic triad, but today most are found incidentally on imaging done for something else. RCC is also the great mimic — its paraneoplastic syndromes can announce it before any urinary symptom. The management pivot is surgical and increasingly nephron-sparing: partial nephrectomy where feasible, radical when necessary. Knowing the benign mimics (oncocytoma, angiomyolipoma) and the childhood tumour (Wilms) rounds out the picture.
The framework: RCC — risk, the (now rare) classic triad, paraneoplastic syndromes, imaging/staging, surgery — plus the key non-RCC tumours.
Mechanism pathway
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Diagnostic algorithm
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Board traps
The classic triad (haematuria + flank pain + mass) is now rare (~7–10%) and means advanced disease — most RCC is incidental.
RCC causes paraneoplastic syndromes (polycythaemia, hypercalcaemia, hypertension, fever) — it can present that way.
Smoking is the main risk factor; VHL underlies hereditary clear-cell RCC.
Angiomyolipoma is fat-containing on CT (benign); oncocytoma mimics RCC.
Favour partial (nephron-sparing) nephrectomy when feasible.
Wilms tumour is the commonest solid renal tumour of childhood.