ABSTRACT
The classic presentation of renal cell carcinoma (RCC) is a triad of symptoms and signs: haematuria, loin pain, and a palpable flank mass. This triad is now often referred to as the ‘too late triad’ and is rarely seen outwith the medical student’s textbook. Even in the 1950s, prior to modern imaging techniques, it was noted that presentation with the classic triad was rare, and associated with advanced disease.1 Studies by Jayson and Saunders in 19982
and Skinner et al in 19713 both from America, have shown that presentation with the classic triad is rare, comprising less than 2% and 10% of symptomatic presentations, respectively. The overall presentation of RCC is changing with increasing numbers of patients diagnosed with asymptomatic, incidentally detected tumours. The figures are now historical, but it was estimated that in the late 1990s over 60% of renal tumours were diagnosed incidentally, compared with around 10% in the early 1970s.2-4 This change has been linked to a significant increase in use of non-invasive imaging such as ultrasound and computed tomography (CT) throughout the population, and a population that is ageing as a whole. However, no figures regarding modes of presentation in the 21st century have been published to confirm this trend. Though incidental diagnosis may lead to an increase in numbers of early-stage tumours, figures from the American SEER (surveillance, epidemiology, and end results) study show an increase
in all stages of renal cancer including metastatic disease.5
