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Renal Mass
Introduction
Renal masses are abnormal growths or neoplasms in the kidney. Most renal masses are benign; however, a significant number require further evaluation and possibly intervention. The retroperitoneum's anatomy, signs, symptoms, and physical examination findings are often insufficient for detecting renal masses. Imaging modalities, eg, computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound, are used to diagnose such masses.
Renal masses are classified into either solid or cystic. This course will focus on solid tumors with minimal discussion on the renal cystic lesions discussed elsewhere. Please see StatPearls' companion resources, "Simple Renal Cyst" and "Renal Cystic Disease", for further information.[1][2] The primary concern for a solid renal mass is renal cell carcinoma, of which there were about 81,000 new cases in 2024 and an estimated 14,000 deaths in the United States, according to the American Cancer Society. The 5-year survival rate for renal cancer significantly increases with early diagnosis. Based on data from the Medicare SEER (Surveillance, Epidemiology, and End Results) database between 2013 and 2019, the 5-year survival rate for localized disease was 93%, for regional disease 74%, and for distant disease 17%.[3] Therefore, diagnosing and evaluating new renal masses is essential to improving patients' quality of life and prognosis through early diagnosis and treatment.
Arguably, the most critical indication of malignancy is the tumor size. Renal masses are commonly divided into masses <4 cm and those >4 cm in diameter. Because of the advancement of imaging tests, eg, CT, MRI, and ultrasound, more masses are detected incidentally during evaluations for unrelated conditions. For example, a cross-sectional study performed in 2011 showed that renal masses are found incidentally in 14% of patients who underwent CT colonography.[4]
The subject of renal masses is diverse, with many nuances in treatment and management. This course will explore the evaluation of solid renal masses, emphasizing small renal neoplasms because of their clinical practice relevance and the etiologies, diagnosis, and management of renal masses with a focus on renal cell cancer.
Renal Malignancies
While renal cell carcinomas are the most common primary kidney malignancies, other cancers that can originate within the kidney include:
Transitional cell carcinoma
Transitional cell carcinoma of the renal pelvis accounts for 6% to 7% of all primary kidney cancers.[5] About 60% of these tumors are not discovered until they are in advanced stages.[5] In low-risk cases, renal sparing treatment can be used. Endoscopic ablation can be considered in selective cases, but regular ureteroscopic follow-up is required. Higher risk cases will typically require nephroureterectomy or cisplatinum-based chemotherapy.[5] Nivolumab, gemcitabine, and carboplatin may be used but are not preferred over cisplatinum. Checkpoint inhibitors (atezolizumab or pembrolizumab) may be helpful for patients with PD-1/PD-L1–positive lesions.[5]
Malignant sarcoma of the kidney
Malignant sarcoma of the kidney is an extremely rare and aggressive lesion that accounts for only about 1% of all renal malignancies. This tumor develops in the connective or adipose tissue around the kidney and can easily spread to adjacent organs. Primary treatment is surgical, particularly for low-grade, early-stage sarcomas. More advanced or aggressive tumors may require additional chemotherapy, radiation therapy, targeted therapy, or immunotherapy.[5][6] Malignant renal sarcomas have a relatively poor prognosis with a 5-year survival rate of about 46%, which drops to 8% in patients with metastatic disease.[7] Please see StatPearls' companion resources, "Sarcoma", for further information.[8]
Wilms tumor (nephroblastoma)
Wilms tumor (nephroblastoma) is the most common type of kidney cancer in the pediatric age group (followed by clear cell sarcoma), most commonly affecting children from 3 to 5 years of age. Approximately 90% of Wilms tumors will have "favorable" histology and enjoy a good prognosis with over 90% survival. The prognosis is not as good for those with "unfavorable" histology. Treatment is primarily surgical, followed by chemotherapy. Please see StatPearls' companion resources, "Wilms tumor", for further information.[9]
Benign renal neoplasms
Benign renal neoplasms include adenomas, angiomyolipomas (hamartomas), cysts, fibromas, hemangiomas, lipomas, and oncocytomas.
Etiology
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Etiology
The causes of renal mass are multifactorial. Specifically, studies have found that smoking increases the risk of renal cell carcinoma in a dose-dependent fashion.[10] An estimated 30% of renal cell cancers in men and 24% of such malignancies in women are related to smoking.[10][11] Moreover, even smoking only a few cigarettes a day increases the risk of renal cell carcinoma.[10] Other classical precipitation agents, eg, asbestos, benzene, cadmium, herbicides/pesticides (eg, atrazine, cyanazine, paraquat, chlorpyrifos, and chlordane), organic solvents, perfluorooctanoic acid (PFOA), perfluoroalkyl and polyfluoroalkyl substances, trichloroethylene (TCE), and vinyl chloride, are known to increase the risk of renal cell carcinoma.[12][13][14][15][16][17][18][19]
Furthermore, several medications have also been implicated. For example, a prospective study by Cho et al showed that non-steroidal anti-inflammatory drugs correlate with the increased risk of cancer.[18][20] Acetaminophen use and certain antihypertensives, including ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and diuretics, have also been associated with an increased risk of renal cell carcinoma.[18][21][22] However, only limited studies on these associations, so further evaluation and validation are needed.
Genetics plays a role in the formation of renal masses as well. The most common example is polycystic kidney disease.[23][24][25][26] In this condition, autosomal dominant and autosomal recessive forms can occur. The recessive form is more aggressive and often fatal. Both of these have a high potential for aggressive, malignant kidney masses.[23][24][25] Other genetic disorders associated with renal mass development include tuberous sclerosis complex, Von Hippel-Lindau, and Birt-Hogg-Dube syndromes.[27][28][29][30][31] Interestingly, medical pathologies such as hepatitis C and nephrolithiasis stones are also associated with an increased incidence of renal cell carcinoma.[32][33]
Epidemiology
Kidney and renal pelvic cancers are the 8th most common cancer in the United States (US), with more men affected roughly twice as often as women.[34] Men also tend to have more aggressive and larger tumors, as well as worse outcomes.[34] Middle-aged White and Black individuals are equally affected, with Asians being the least affected. Renal cell cancer is most commonly found in North America and Europe and is rare in individuals younger than 15 years of age.[35]
Globally, almost 270,000 new cases of renal cancers are diagnosed every year, accounting for about 4% of all adult malignancies.[36] In recent decades, the incidence of renal masses has increased because of improved sensitivity and usage frequency of advanced imaging modalities such as MRIs and CTs. Therefore, it is unsurprising to find such renal masses in healthy individuals. On the other hand, the incidence of newly discovered malignant renal tumor cases has been holding steady, with the 5-year survival rate steadily improving due to advancements in detection and intervention.[37][38]
Renal cell carcinoma is more common in certain groups, eg, patients with end-stage kidney disease, individuals on dialysis, acquired renal cystic disease, and renal transplant recipients.[39]
History and Physical
Renal masses are frequently found incidentally without any apparent clinical signs or symptoms. The classic triad of flank pain, palpable flank or abdominal mass, and hematuria is seen infrequently in modern medicine because the lesions have already been detected by imaging before developing clinical symptomatology. The classic triad is observed only in approximately 10% to 15% of cases, most of which are in advanced stages. However, if these findings are present, then they warrant further evaluation.
History taking should be thorough and explore information, eg, smoking history, eating habits, exercise status, comorbidities, and exposures to known cancer-causing agents. The medical literature suggests that obesity, hypertension, and smoking are present in up to 50% of cases.[40] Furthermore, high body mass index, elevated triglycerides, and increased blood glucose levels seem to increase the risk of renal cell carcinoma.[41]
Occupational exposure to dye-containing hydrocarbons has long been thought to cause renal cell cancers, but recent literature is still somewhat inconclusive and requires further assessment.[42][43][44] Such risks have significantly decreased with better recognition of the potential dangers and improved safety practices.
A positive family history of renal cell carcinoma is significant as it increases the renal cancer risk by almost 3-fold.[45][46] Research has linked conditions, eg, end-stage renal disease, to renal cell cancer because it tends to induce renal cystic development, leading to aberrant cell formation.[47][48][49][50] Also, patients with a family history of genetic conditions, eg, polycystic kidney disease, are at a higher risk, requiring close monitoring.[23][24][25]
Clinical Symptoms
Symptoms most commonly associated with renal cell carcinoma include loss of appetite, fatigue, anemia, fever not due to known infections (eg, a cold or flu), flank pain, hematuria, hypertension, unexplained weight loss, and night sweats.
Fatigue
Fatigue is a common symptom, present in about 70% of patients who present with renal cell carcinoma.[51] Multiple causes are involved, including serotonin dysregulation, changes in muscle metabolism, ATP metabolic alterations, hypothalamic-pituitary-adrenal axis dysfunction, abnormal circadian rhythm, increased cytokines, depression, anemia, and sleep disorders.[51][52][53][54] Anemia is present in about 30% to 40% of cases and is caused by urinary blood loss, reduced erythropoiesis, and tumor-related factors affecting red blood cell production.[55]
Hematuria
Hematuria is the most common sign of possible renal cell carcinoma, being identified in about 35% of cases.[56] Gross hematuria is the single most critical sign of a renal malignancy. It suggests penetration of the renal pelvis by the tumor but is not considered a sign of metastatic disease.[57] The degree of hematuria generally correlates with the tumor stage and prognosis.[57]
Hypertension
Hypertension is a known risk factor for renal cell carcinoma. The hypertension can be due to the renal cancer directly, tumor-induced renal artery compression or obstruction, generation of vasoactive substances, increased tumor renin production, paraneoplastic syndrome, arteriovenous fistula formation, or ectopic hormone production.[58][59][60][61][62] A meta-analysis of 18 studies found that for each 10 mm Hg increase in systolic blood pressure, there is a 5% increase in the incidence of renal cell carcinoma.[63]
Unexplained weight loss and night sweats
Night sweats may also be associated with renal cell carcinoma, especially when metastatic.[64] The exact cause is unclear, but it is thought to be related to a bodily inflammatory tumor response (cytokine release, tumor necrosis factors), paraneoplastic syndrome, and hormonal factors.[65]
Rapid or significant unexplained weight loss is another potential sign of renal cell carcinoma. This can occur at any cancer stage and may be the first identifiable symptom of the disease. About 27% to 30% of renal cell cancer patients will demonstrate weight loss before diagnosis and treatment. The weight loss is due to decreased appetite, release of tumor-related chemical factors that lead to cachexia, loss of appetite, and increased use of bodily energy resources to fight the malignancy. Cancer cachexia is not improved with nutritional supplements alone, suggesting that various cancer-associated tumor factors and cytokines may be responsible.[66] Weight loss may also help predict the recurrence rate of renal cell cancer after nephrectomy.[67]
Fever
Fever, either persistent or intermittent, is generally seen in about 20% of patients with a renal malignancy.[68] The incidence increases as the renal lesion enlarges.[68] Unexplained, persistent, and significant fever tends to be associated with more advanced stages of the disease. This has been associated with higher serum IL-6 levels, more advanced disease, and poorer performance status.[68][69][70]
Physical Examination
The physical examination is not generally helpful unless a palpable flank or abdominal mass is discovered, which is identifiable in about 25% of patients. The examination should include an evaluation of varicoceles in male patients with venous tumor invasion, especially if the varicocele is on the right side or develops acutely.[71][72] Abdominal bruits, enlarged supraclavicular nodes, facial flushing, loss of muscle mass, and skin pallor may also be present.
Evaluation
Renal Mass Evaluation
Evaluation of a renal mass is diverse, depending on the patient's presentation, demographics, and symptomatology. Patients with symptoms and signs, eg, hematuria, palpable flank mass, unexplained persistent fevers, significant unplanned weight loss, or flank pain should be further evaluated. Patients should undergo laboratory tests and advanced imaging, including ultrasound, CT, and MRI.
Experts recommend that the laboratory evaluation should include a complete blood count (CBC), a urinalysis, liver function tests, and a comprehensive metabolic panel including serum creatinine, calcium, hemoglobin, leukocyte and platelet counts, lymphocyte-to-neutrophil ratio, and serum-corrected calcium.[35] Abnormal laboratory findings may include anemia, polycythemia (rare, only found in 1% to 3% of cases due to excessive erythropoietin production), microscopic hematuria, hypercalcemia (in paraneoplastic syndrome), and an increased erythrocyte sedimentation rate (ESR). These findings can be helpful, even if nonspecific. In general, laboratory findings may be suggestive but are not diagnostic in evaluating renal masses without imaging and further testing.
Renal Mass Imaging Studies
Ultrasound
Ultrasound is often the initial imaging modality employed due to its low cost, availability, and lack of ionizing radiation. However, it is not considered definitive in cases of high suspicion, such as hematuria. The decision to use CT or MRI depends on the tumor characteristics and the patient's clinical signs and symptoms.
Computed tomography and magnetic resonance imaging
CT is best used when fast imaging acquisition is preferred or a contraindication to MRI (eg, patients with metallic implants) is identified. In contrast, MRI is preferred for the characterization of smaller renal lesions with the benefits of no radiation exposure (in comparison to the brain MRI required as part of the staging imaging in a metastatic renal cell workup, where an MRI has increased sensitivity at detecting brain metastases as compared to CT imaging).
Additionally, tumor size is an essential consideration in evaluating renal masses. In general, tumors smaller than 3 to 4 cm have lower malignant potential than larger tumors. Up to 40% of 2 cm renal masses are benign, and only a small percentage, 10%, are high-grade renal cell carcinoma.[73][74] In contrast, up to 30% of 4 cm or larger renal masses will be high-grade malignancies.[75] A lower threshold should be used for further evaluation with larger renal masses due to their higher malignant potential.
Evaluating asymptomatic patients with incidental findings of a renal mass is essential. Most renal masses are benign, but carcinoma is a significant concern. Some signs may be notable on advanced imaging to differentiate benign from malignant lesions. For instance, on a CT scan, fat is less dense than water and soft tissues. Therefore, density readings of the lesion of less than -10 to -20 Hounsfield units (HU) have significant fat content and likely indicate an angiomyolipoma, a benign tumor.[76] In contrast, substantial enhancement after IV contrast suggests that the tumor is lipid-poor and vascular, with a much higher malignant potential. In general, an enhancement of greater than 15 to 20 HU on CT suggests renal cell carcinoma.[35][77]
Renal Mass Genetic Analysis
A genetic analysis will be needed in some patients with renal cell malignancies. This is recommended in the following situations: [35]
- Bilateral or multiple tumors
- Individuals with related disorders who are known to be predisposed to renal cell cancer
- Patients with a positive family history of renal cell carcinoma (first or second-degree relatives)
- Therapeutic failures
- Younger patients
Renal Malignancy Evaluation
A metastatic workup should be performed if there is a reasonable suspicion of renal cell carcinoma. The most common site for metastatic renal cell cancer is the lung (75%), followed by soft tissues, bone, liver, and brain.[78] Evaluating such patients with comprehensive imaging, including CT/MR abdominopelvic imaging, a CT chest, and a brain MRI, is helpful. The IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) risk model includes laboratory findings, eg, hemoglobin, calcium level, absolute neutrophil count (ANC), and platelet count into consideration (along with patient functional performance status and time from diagnosis to initiation of systemic therapy).[79]
Treatment / Management
Renal Biopsy
A renal biopsy is indicated when the tumor characteristics and imaging are inconclusive or equivocal. Significant nondiagnostic results (15%) after a renal biopsy require patients to undergo additional biopsies.[80] Risks of hematoma, renal failure, and other complications are also present. A renal biopsy is only indicated in certain situations. Biopsies are commonly performed when a patient is a surgical candidate; the biopsy results help guide management. Biopsies are also of value in providing tumor pathology but are not indicated if the result would not impact management. One typical example of an unjustified biopsy would be when the renal mass is <1 cm.[81]
Sometimes, despite our best efforts, a definitive diagnosis between benign and malignant cannot be made without a tissue sample, the patient is a nonsurgical candidate, the tumor is not surgically resectable, lymphoma is suspected, or a biopsy is needed for some other reason.[81] The results of a single biopsy will not be definitive in about 15% of cases, and the procedure must then be repeated.[80]
A renal biopsy should not be performed if the result would not affect treatment, eg, in renal masses <1 cm in size or in patients who will undergo surgery regardless.[81][82] A renal biopsy has been suggested in smaller solid renal lesions (<4 cm), where 26% of such lesions were benign and did not require surgery.[83] Please see StatPearls' companion resource, "Renal Biopsy," for further information.[81](B3)
Renal Biopsy
Indications for a renal biopsy include:
- Need for histologic evaluation before ablative therapy of the renal mass
- Differentiating benign from malignant lesions when imaging is equivocal
- High surgical risk patients (to avoid unnecessary major surgery for benign lesions)
- Pretreatment planning that cannot otherwise be determined (eg, surgery, active surveillance, or ablation)
- Patients being considered for active surveillance
- Patients with a single or uncharacteristic metastasis (biopsy of the metastatic lesion to determine if it is renal in origin)
- Suspicion of a nonrenal primary (metastatic disease to the kidney, lymphoma) or a benign condition, eg, an abscess or focal pyelonephritis
- When genetic analysis or molecular markers are required in nonsurgical situations
- Unresectable renal mass (necessary for a definitive histological diagnosis and treatment planning) [81][82][84] (B3)
Management of Renal Masses
The optimal management of renal masses varies depending on multiple factors, including patient size, shape, and renal tumor pathology. Different interventions include close monitoring, biopsy, surgical resection, and thermal ablation. Choosing one intervention over another depends on balancing the risks and benefits. As with many other interventions, taking a patient's age, comorbidities, risk factors, and renal functional status (or potential dialysis risk) into consideration is essential. For example, offering patients with a short life expectancy either active surveillance or ablation is beneficial, depending on tumor characteristics, as they are more likely to succumb to their comorbidities or surgery than from the untreated malignancy.
Active surveillance of small renal masses
Active surveillance is indicated in many situations, especially in small masses with benign characteristics. When a tumor is <1 cm with a gradual growth rate, further imaging and biopsy are not beneficial due to minimal malignant transformation risks. These patients should be offered active surveillance instead. Surveillance should also be provided to patients who are not surgical candidates. An older adult with a short life expectancy and a <4 cm tumor size is a suitable candidate for active surveillance. Although no unified guideline has been established for the frequency of active surveillance, consensus indicates that renal ultrasound, CT, or MRI can be used for monitoring renal mass every 3 to 6 months for the first year. Active surveillance can be spaced out depending on the renal pathology and progression.[85]
Small renal masses are the ones most appropriate for management with active surveillance. Small renal masses are defined as solid neoplasms of the kidney <4 cm in size. Such small renal lesions tend to be indolent, have slow growth rates of no more than 3 mm per year, and have a very low risk of metastasis.[86] As such, active surveillance is an appropriate and reasonable treatment option for small renal masses.[86][87][88][89][90] Large renal neoplasms may also be managed with active surveillance, but this is associated with a greater risk and should be used cautiously and selectively.[91](A1)
In general, according to ASCO and AUA Guidelines, active surveillance is reasonable for smaller renal lesions in older patients, those with multiple comorbidities, high surgical risk, or those who have a limited life expectancy.[86][90][92][93] Patients should be fully informed of their options and be reliable for required follow-up examinations. They should be prepared to accept additional therapy when warranted. Repeat imaging should be performed at least every 6 months for monitoring.(A1)
Active surveillance should be considered in the following situations:
- Initial management of renal masses <2 cm, even if suspicious for malignancy.
- It may also be selectively considered for tumors 3 to 4 cm in size.
- Optional in cases where the risks or complications of procedural intervention outweigh the potential benefits
- Borderline and equivocal cases, where it is the patient's preference after shared decision-making
- Marginal renal function
- Life expectancy of <5 years
- Significant comorbidities such as end-stage renal failure [86][90][92][93] (A1)
Active surveillance of renal masses is not appropriate in the following situations:
- Renal masses reliably diagnosed as benign, where active surveillance is deemed unnecessary
- Renal neoplasms with unusual characteristics, such as irregular borders
- Advanced or metastatic lesions
- Where the benefits of treatment significantly surpass the risks of procedural intervention or oncologic treatment
- When the patient declines active surveillance or required follow-up [86][90][92][93] (A1)
Favorable tumoral factors for active surveillance include:
- Lesion size <3 cm
- Significant cystic component
- Tumor growth of <5 mm annually
- Low complexity, noninfiltrative appearance
- Favorable histology [93]
Thermal ablation or cryotherapy
Thermal ablation or cryotherapy is indicated in patients who are not surgical candidates or who prefer a less invasive approach to tumors of acceptable size and location. This treatment is most useful for tumors smaller than 3 to 4 cm. Ablations are less invasive than surgery; however, they increase the risk of cancer recurrence, require close regular surveillance, and still have the potential need for further treatment at a later date.
Surgical treatment
Surgery is the most definitive intervention for malignant renal masses. The 2 most common procedures are partial and radical nephrectomy. Partial nephrectomy is preferred when possible as it preserves kidney function compared to radical nephrectomy, especially in patients with chronic kidney disease stage 3 or worse.[92] However, an increased risk of bleeding is present in partial nephrectomy. Total nephrectomy should be preferentially considered when a tumor has unfavorable pathology or is larger than 5 cm.[94] Please see StatPearls' companion resource, "Renal Cancer," for further information.[95](A1)
Differential Diagnosis
Clinicians should exclude infection and abscess whenever a renal mass is identified, as antibiotics (or aspiration and drainage) may be required. When an infection is ruled out, further investigation is needed for malignant etiologies, including renal cell carcinoma, metastasis, or lymphoma. While investigating malignancies, it is crucial to identify benign tumors such as an oncocytoma, angiomyolipoma, or adenoma. These usually require only active surveillance, with no interventions needed.
- Adenoma
- Adrenal tumors
- Angiomyolipoma
- Collecting duct carcinoma
- Fibroma
- Hemangioma
- Infection and abscess
- Lipoma
- Lymphoma
- Metastatic lesion from a non-renal primary
- Oncocytoma
- Malignant renal sarcoma
- Renal cyst
- Renal infarction
- Renal medullary carcinoma
- Transitional cell carcinoma of the renal pelvis
- Wilms tumor (nephroblastoma)
Prognosis
The prognosis for a renal mass depends on the histology and whether a malignant tumor is identified. As with most other cancers, the survival rate improves with early diagnosis and treatment. According to the American Cancer Society, the 5-year survival rate for localized disease in renal cell carcinoma is 93%, for regional disease 74%, and for distant disease 17%.
The KEYNOTE-564 study examined the role of the adjuvant immunotherapy pembrolizumab following nephrectomy in renal cell carcinoma. Patients were eligible if they had "tumor stage 2 with nuclear grade 4 or sarcomatoid differentiation, tumor stage 3 or higher, regional lymph-node metastasis, or stage 1 M1 with NED" following surgical resection.[96] The study found that adjuvant pembrolizumab for 1 year post-nephrectomy improved overall and progression-free survival (PFS).[96]
For other types of tumors, classical variant angiomyolipomas have a prolonged growth rate. In a case report, 90% of tumors with a size of less than 1.5 cm have no growth over the 5-year follow-up.[97] The epithelioid variants, however, have a small but significant potential for malignant transformation. A small case series indicates that out of 40 participants, about 9 (26%) had malignant transformation.[98] The primary risk of angiomyolipomas is hemorrhage and bleeding, which can generally be managed by selective renal arterial embolization.
Oncocytoma is primarily benign and well-organized compared to renal cell carcinoma. They are encapsulated and not invasive. However, renal cell cancer may be seen in up to 30% of patients who have an oncocytoma. As a result, they should be closely monitored for renal malignancy.
A metanephric adenoma is benign but can present similarly to renal cell carcinoma in symptomatology. For example, patients may present with the classical triad of flank pain, hematuria, and a palpable mass. One difference is that they present more frequently in females than males, unlike their renal cell carcinoma counterparts. A biopsy with histology is the primary way to diagnose this type of neoplasm, and it is only indicated if surgery is not being planned. Up to 90% of adenomas have a BRAF V600 mutation.[99] Due to the tumor pathology, there is no absolute surgical indication since it is benign.
In general, surgery is indicated for larger renal masses, when the diagnosis is uncertain, if the neoplasm is causing symptoms, when there is rapid growth of the tumor, or by patient request.[100]
Complications
Balancing the risks and benefits of intervention versus active surveillance is vital. When surgery is indicated, evaluating the risk of anesthesia, infection, bleeding, and renal failure is critical. Therefore, patients should be carefully assessed before undergoing invasive procedures. Ablation is an option when a patient is not a candidate for surgery. Allowing a potential renal malignancy to grow and spread too far before initiating therapy, risking possible metastases, is another risk.
Although ablation has fewer complications than surgery, the risk for recurrence requiring multiple treatment sessions is higher in the ablation group. Therefore, physicians and other healthcare professionals must fully inform patients about the alternatives, risks, and benefits before undergoing interventions.
Deterrence and Patient Education
Educating patients on the risk factors for renal cell carcinoma, eg, smoking, alcohol use, obesity, genetic, environmental exposure, and dialysis, is essential. Patients should be counseled to quit smoking and alcohol and increase their dietary intake of vegetables and fruits. These qualities have been shown to correlate with a lower rate of renal cancer. Depending on the clinical and renal pathology, patients should be offered genetic counseling to the patient and their families, such as Von-Hippel Lindau, hereditary leiomyomatosis and renal cell cancer, Birt-Hogg-Dubé syndrome, and hereditary papillary renal carcinoma.
Workers exposed to toxic agents such as polycyclic aromatic hydrocarbon groups should be further evaluated. Still, studies have been inconclusive about the actual link of such exposure to renal cell carcinoma.[101] Literature has linked medications to renal cell carcinoma. A 2011 prospective study showed that the more prolonged use of nonaspirin, non-steroid anti-inflammatory drugs correlates with increased renal cell carcinoma risk.[20] This is the first study of its kind, and further evaluation is needed to solidify this finding; therefore, discussion of the risks and benefits of their medications with patients is required.
Enhancing Healthcare Team Outcomes
Enhancing patient-centered care and improving outcomes for individuals with renal masses requires a coordinated interprofessional approach that emphasizes teamwork, clear communication, and shared responsibilities. Physicians, advanced practitioners, nurses, pharmacists, and allied health professionals each play a critical role in identifying, monitoring, and managing renal masses. Skills such as early detection, risk assessment, and personalized treatment planning are strengthened through strategic collaboration. Dietitians and physical therapists contribute by educating patients on the importance of healthy lifestyle changes, including diet and weight loss, which may reduce the risk of malignant renal masses and support overall health.
Primary care clinicians and nurses are responsible for promoting long-term patient engagement by emphasizing the need for regular follow-up visits, adherence to prescribed medications, and lifestyle modifications such as cessation of alcohol and tobacco use. Urologists and oncologists lead diagnostic and therapeutic strategies, while pharmacists ensure safe and effective medication use, monitor for adverse effects, and contribute to patient education. Together, through coordinated care and open interprofessional communication, healthcare teams enhance patient safety, streamline treatment delivery, and improve clinical outcomes. This collaborative model benefits the patient and elevates team performance across the continuum of care.
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