A renal mass, or tumor, is an abnormal growth in the kidney. Some renal masses are benign (not cancerous) and some are malignant (cancerous). One in four renal masses are benign. Smaller masses are more likely to be benign. Larger masses are more likely to be cancerous.
Kidney cancer -- also called renal cancer -- is a disease in which kidney cells become malignant (cancerous) and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma.
This AUA Guideline focuses on the evaluation and management of clinically localized sporadic renal masses suspicious for renal cell carcinoma (RCC) in adults, including solid enhancing renal tumors and Bosniak 3 and 4 complex cystic renal masses. Some patients with clinically localized renal masses may present with findings suggesting aggressive tumor biology or may be upstaged on exploration or final pathology. Management considerations pertinent to the urologist in such patients will also be discussed. The follow-up of renal cancer patients after intervention is also addressed, including recommendations for periodic clinical follow-up and abdominal and chest imaging. Practice patterns regarding such tumors vary considerably, and the literature regarding evaluation, management, and surveillance has been rapidly evolving. Notable examples include controversies about the role of renal mass biopsy (RMB) and concerns regarding overutilization of radical nephrectomy (RN).
"Renal cancer is one of the ten most common cancers in both men and women," said Steven C. Campbell, MD, PhD, chair of the Renal Mass Guideline Panel. "We believe this revised guideline will provide a useful, evidence-based clinical reference for the medical and surgical management of renal masses and localized renal cancer."The Guideline was amended as follows:
- Updates on recommending genetic counseling for patients - Clinicians should recommend genetic counseling for any of the following: all patients ≤ 46 years of age with renal malignancy, those with multifocal or bilateral renal masses, or whenever 1) the personal or family history suggests a familial renal neoplastic syndrome; 2) there is a first-or second-degree relative with a history of renal malignancy or a known clinical or genetic diagnosis of a familial renal neoplastic syndrome (even if kidney cancer has not been observed); or 3) the patient's pathology demonstrates histologic findings suggestive of such a syndrome.
- Updates on renal mass biopsy (RMB) - Patients should be counseled regarding rationale, positive and negative predictive values, potential risks and non-diagnostic rates of RMB. (This statement is now evidence based).
- Clinicians should consider RMB when a mass is suspected to be hematologic, metastatic, inflammatory, or infectious and for patients with a solid renal mass who elect RMB, multiple core biopsies should be performed and are preferred over fine needle aspiration.
- Updates on radical nephrectomy (RN) - Clinicians should consider RN for patients with a solid or Bosniak 3/4 complex cystic renal mass whenever increased oncologic potential is suggested by tumor size, RMB (if obtained), and/or imaging.
- Updates on thermal ablation (TA) - Clinicians should consider TA as an alternate approach for the management of cT1a solid renal masses <3 cm in size. For patients who elect TA, a percutaneous technique is preferred over a surgical approach whenever feasible to minimize morbidity. This also includes changing the statement from a conditional to a moderate statement.
- Updates on active surveillance (AS) - For patients with a solid or Bosniak 3/4 complex cystic renal mass in whom the risk/benefit analysis for treatment is equivocal and who prefer AS, clinicians should consider RMB (if the mass is solid or has solid components) for further oncologic risk stratification and for patients with a solid or Bosniak 3/4 complex cystic renal mass in whom the anticipated oncologic benefits of intervention outweigh the risks of treatment and competing risks of death, clinicians should recommend intervention. AS with potential for delayed intervention may be pursued only if the patient understands and is willing to accept the associated oncologic risks.
- A new section labeled "other considerations"
Additionally, this guideline now includes follow-up care for renal mass patients.
Members of the Renal Mass Guideline Panel: Steven Campbell, MD, PhD; Robert G. Uzzo, MD; Sam S. Chang, MD; Peter E. Clark, MD; Jose A. Karam, MD; Lesley Souter, PhD
Source: "American Urological Association Announces Updates To Clinical Guidance For Renal Mass And Localized Renal Cancer". 2021. American Urological Association Mediaroom.