# Kidney cancer - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class UD25 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Renal Cancer - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK558975/ - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text KIDNEY CANCER Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class UD25 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Renal Cancer - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK558975/ Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - It stays silent until late, and more than half of these tumours are found by accident on a scan - Only 10 to 15% show the classic triad of flank pain, blood in the urine and fullness in the flank [abdominal pain · blood in the urine · loin pain] - Historically more than 60% presented with blood in the urine and nothing else [blood in the urine] - Other features are tiredness, weight loss, fever, night sweats, feeling unwell, high blood pressure and anaemia [anaemia · fatigue · fever · hypertension · malaise · night sweats · weight loss] - A high calcium means either spread to bone or a paraneoplastic effect - Red flag: severe sharp band-like back pain can mean a collapsed vertebra with cord compression from secondary deposits [back pain · collapse] SIGNS - what you find (4) - A varicocele can appear when tumour grows into the renal vein and vena cava and blocks the testicular vein - Deposits in bone eat it away, causing fractures through weakened bone, cord compression and a high calcium - Called the great mimic for its paraneoplastic syndromes: high calcium from PTHrP, too many red cells from erythropoietin, Cushing syndrome from ACTH - A third already have spread when first seen, so examine for deposits in lung (75%), bone (20%), liver (18%) and brain (8%) TESTS (12) - Start with urinalysis and urine cytology, particularly where a urothelial tumour is possible - Full blood count and ESR to judge anaemia and platelets - Kidney function and electrolytes decide whether contrast can be given for imaging - Liver tests separate real liver deposits from Stauffer syndrome, the non-metastatic liver upset; calcium is checked too - Ultrasound of the kidney is usually the first study, sometimes with a CT excretory urogram - A staging CT of abdomen and pelvis confirms it - Chest film or CT looks for lung deposits - MRI assesses growth into veins and the spread of disease, and serves where contrast cannot be given - Bone scan with alkaline phosphatase for bone deposits and follow-up; CT of the head if brain spread is suspected - Suspected cord compression needs an urgent MRI - Genetic testing when an inherited syndrome is likely, because of young age or a family history - Needle biopsy guided by ultrasound or CT is possible for a suspicious solid or cystic lesion, and no blood or urine marker is yet validated, so imaging carries the diagnosis IF NOT THIS - what else fits (12) - Any renal mass found on a scan should raise this possibility, since half are found by chance and the disease is usually silent - Renal abscess - Benign tumours: angiomyolipoma, oncocytoma and renal adenoma - Lymphoma of the kidney - A simple renal cyst - Infarction of the kidney - Renal sarcoma - A deposit from a cancer elsewhere, such as melanoma - Acute or chronic pyelonephritis - Bladder cancer - Non-Hodgkin lymphoma - Adult-type Wilms tumour Source StatPearls "Renal Cancer" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Renal cell carcinoma requires surgical and oncologic management; the GP's role is recognising suspicious features (blood in urine, flank mass, weight loss) and referring urgently. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Renal cell carcinoma requires surgical and oncologic management; the GP's role is recognising suspicious features (blood in urine, flank mass, weight loss) and referring urgently. Caution RED FLAG - Paraneoplastic hypercalcaemia (confusion, severe thirst, polyuria) or polycythaemia: assess urgently and refer. Painless visible blood in the urine, a palpable flank mass, or unexplained weight loss are urgent referral triggers for suspected kidney malignancy. No medicine is prescribed for this in primary care - this entry is for recognition and referral. 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