Renal cell carcinoma. Guidelines for diagnosis and treatment

Diagnosis of renal cell carcinoma (RCC) is established using sonography and confirmation by computed tomography (CT). Due to the widespread use of these imaging techniques for numerous indications, small renal tumors are increasingly detected by chance. As the sensitivity of CT is very high, treatment of RCC is routinely initiated without histological confirmation. Standard therapy of locally confined tumors without evidence of lymph node or hematogenic metastases is nephrectomy. However, the results of tumor excision equal those of nephrectomy if tumor size does not exceed 4 cm in diameter. Whereas the prognosis of organ-confined tumors is excellent, no curative treatment for primary metastasized RCC is available to date. Immunotherapy - the only systemic treatment modality with clinically relevant response rates - has so far failed to effect a survival advantage for the patient. Surgery is only potentially curative for asychronous metastases occurring more than 2 years after surgery.