Initial evaluation and treatment of renal cell carcinoma

IVC: inferior vena cava; CT: computed tomography; MRI: magnetic resonance imaging.
* Preliminary diagnosis is based upon characteristic findings on imaging studies (CT/MRI); tissue diagnosis is generally obtained at time of definitive surgery.
¶ Chest imaging, additional studies as clinically indicated to look for evidence of metastases.
Δ Selection of patients should be done with considerable care so that appropriate patients can proceed with systemic therapy; important factors include good performance status, ability to perform adequate debulking, and favorable- or low-intermediate-risk diseases. Refer to UpToDate topic on the role of surgery in patients with metastatic renal cell carcinoma.
◊ Partial nephrectomy is the preferred approach to confirm the diagnosis and treat a renal mass <4 cm. However, thermal ablation (cryotherapy, radiofrequency ablation) or active surveillance may be appropriate alternatives for patients who are not surgical candidates. The choice between these approaches is guided by local expertise and patient preference. Refer to UpToDate topic on the diagnostic approach, differential diagnosis, and treatment of a small renal mass.
§ Based upon factors including patient preference, age, and comorbidities.