ABSTRACT

Renal cell carcinoma (RCC) is an increasingly common clinical problem with 36,160 new cases and 12,660 deaths predicted for 2005 (1). These numbers represent a doubling of the incidence during the last 50 years. This increase is secondary to a combination of (i) an overall increase in the incidence of RCC (2), which is of uncertain etiology, and (ii) a tremendous increase in serendipitous identification of small RCC on cross-sectional imaging performed for other indications (3). As a result, there has been a fivefold increase in the diagnosis of small, less than 3 cm RCC during the last 20 years (4). These tumors tend to grow slowly with a linear growth rate of 0 to 1.1 cm/yr (5), and are frequently diagnosed in older patients. The early diagnosis of these tumors is changing the prognosis and management of the disease. Historically, RCC was frequently diagnosed only after mass effect symptoms or gross hematuria became evident. As a result, the tumor was often very large and metastatic at the time of diagnosis. Thus, RCC had a very poor prognosis and management focused on chemotherapeutic interventions and surgical debulking. If the patient was a surgical candidate, radical nephrectomy was considered the standard of care (6).