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Commentary RE: Increased Incidence of Serendipitously Discovered Renal Cell Carcinoma

  • Steven C. Campbell
    Correspondence
    Address correspondence to: Steven C. Campbell, Department of Urology, Section of Urological Oncology, Glickman, M.D., Ph.D,, Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44915.
    Affiliations
    Department of Urology, Section of Urological Oncology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
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      This article from 1998 is remarkable due to its simplicity but also its clinical impact.
      • Jayson M
      • Sanders H
      Increased incidence of serendipitously discovered renal cell carcinoma.
      In just over 2 pages the authors highlight a major change in the field of kidney cancer, as they reported on 131 patients managed with nephrectomy at Yale between 1989 and 1992. The main finding pertains to a shift to incidental or serendipitous discovery, which was found in the majority of cases (61%) in their series, rather than symptomatic presentation, which was the norm in the decades prior. Only 1 patient presented with the “too late triad” of hematuria, flank pain, and abdominal mass, and only 1 presented with a possible paraneoplastic syndrome. This in contrast to previous series in the literature, such as one from Skinner et al (1971), in which the classic triad of symptoms was observed in 9% of patients and only 7% were asymptomatic.
      • Skinner DG
      • Colvin RB
      • Vermillion CD
      • et al.
      Diagnosis and management of renal cell carcinoma: a clinical and pathologic study of 309 cases.
      As the authors state, “What was once the internist's tumor has become the radiologist's tumor.” Of course this change was driven by better imaging, most notably the introduction of computed tomography and renal ultrasound, and increased utilization of these modalities for a variety of nonspecific complaints.
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      References

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        Increased incidence of serendipitously discovered renal cell carcinoma.
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        Diagnosis and management of renal cell carcinoma: a clinical and pathologic study of 309 cases.
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