[Epidemiology and detection of renal cancer in adults]

The incidence of renal carcinoma in France is 7 for 100,000 men and 3 for 100,000 women. Most cases are found in patients in their sixties or seventies. With the exception of the rare Von Hippel-Lindau disease, the only risk factor is tobacco smoking. The circumstances in which renal carcinoma is discovered have changed during the last few years: 1 out of 2 renal carcinomas are still diagnosed on their classical signs (essentially haematuria), but almost as many other cases are incidentally and unexpectedly detected by abdominal ultrasonography when the carcinoma is totally asymptomatic. The conventional attitude towards these fortuitously discovered renal tumours is the same as for asymptomatic tumours, i.e. widened nephrectomy. In case of small tumours a few centimetres wide, 20% of which are benign, it may be useful to wait a few months and reevaluate the situation prior to considering surgery. In elderly and asymptomatic patients the immediate surgical risk/long-term benefit ratio must be carefully weighed.