[Diagnosis and treatment of renal cell carcinoma]

Renal cell carcinoma is one of the most difficult malignant tumors for early diagnosis. It is rare that the classic symptoms such as hematuria, a renal mass and flank pain appear simultaneously. Only in about 7% of renal cell carcinoma patients these symptoms occurred simultaneously. Hematuria is an important symptom, and in our series 46% of the patients with renal cell carcinomas were conscious of macrohematuria as an initial symptom. As an initial symptom, a mass was palpable in 8% and flank pain was felt in 13% of the patients with renal cell carcinomas. Nonurologic symptoms were observed as initial symptoms in 33% cases, suggesting physician's particular attention on these symptoms. Initial diagnosis of renal cell carcinomas begins with urinary tract x-ray examination, which is followed by ultrasonography, CT scan, and if necessary, angiography. These procedures make definite diagnosis possible and define clinical staging. The most basic and reliable treatment method established for renal cell carcinomas is surgery--radical nephrectomy. Much cannot be expected from chemotherapy or radiotherapy as an adjuvant modality. To what extent lymphoadenectomy should be performed at the time of radical surgery is a question still to be definitely answered, but the lymph node of the renal pedicle should be removed completely. While any chemotherapeutic drug or method has not yet been established, an increasing number of useful agents have been studied. Radiotherapy is now used exclusively as adjuvant therapy for metastatic tumors. In order to improve clinical results, it is necessary to establish an appropriate approach according to clinical stage. In particular, establishment of approach to progressive carcinomas is imperative.