Approximately 38,890 new cases of renal cell carcinoma (RCC) were estimated to be diagnosed in the United States in 2006, with 12,840 cancer-related deaths attributed to cancers of the kidneys and the renal pelvis (1). More than one-half of these patients were diagnosed incidentally on cross-sectional imaging performed for non-related conditions (2). Increased incidental detection of small renal masses as well as advances in surgical techniques have led to development of nephron-sparing procedures for treatment in order to preserve renal function. Over the past decade, the options for the treatment of RCC have evolved to include radical nephrectomy as well as partial nephrectomy, laparoscopic nephrectomy and, in selected cases, percutaneous radiofrequency ablation (RFA) and cryotherapy. Each therapy has unique clinical applications and benefits. This article illustrates various treatment modalities used in the therapy of RCC with special emphasis on percutaneous ablative techniques.

CLINICAL OVERVIEW

RCC accounts for 85% of all renal tumors and is slightly more common in men than in women (1.6 to 1.0) (2). Symptomatic RCC usually presents with a triad of flank pain, hematuria and a palpable abdominal mass. Hematuria, either gross or microscopic, in any patient usually warrants evaluation by a computed tomographic (CT) scan. Other nonspecific symptoms include weight loss, anemia or fatigue. However, almost one-half the patients are asymptomatic at diagnosis and have incidentally detected tumors on cross-sectional imaging. Certain genetic syndromes such as von Hipple-Lindau (VHL) disease increase the incidence of RCC (accounting for approximately 2% of cases of RCC).