Challenges of early renal cancer detection: symptom patterns and incidental diagnosis rate in a multicentre prospective UK cohort of patients presenting with suspected renal cancer

Abstract

ObjectivesTo describe the frequency and nature of symptoms in patients presenting with suspected renal cell carcinoma (RCC) and examine their reliability in achieving early diagnosis.DesignMulticentre prospective observational cohort study.Setting and participantsEleven UK centres recruiting patients presenting with suspected newly diagnosed RCC. Symptoms reported by patients were recorded and reviewed. Comprehensive clinico-pathological and outcome data were also collected.OutcomesType and frequency of reported symptoms, incidental diagnosis rate, metastasis-free survival and cancer-specific survival.ResultsOf 706 patients recruited between 2011 and 2014, 608 patients with a confirmed RCC formed the primary study population. The majority (60%) of patients were diagnosed incidentally. 87% of patients with stage Ia and 36% with stage III or IV disease presented incidentally. Visible haematuria was reported in 23% of patients and was commonly associated with advanced disease (49% had stage III or IV disease). Symptomatic presentation was associated with poorer outcomes, likely reflecting the presence of higher stage disease. Symptom patterns among the 54 patients subsequently found to have a benign renal mass were similar to those with a confirmed RCC.ConclusionsRaising public awareness of RCC-related symptoms as a strategy to improve early detection rates is limited by the fact that related symptoms are relatively uncommon and often associated with advanced disease. Greater attention must be paid to the feasibility of screening strategies and the identification of circulating diagnostic biomarkers.

Circulating Non-coding RNAs in Renal Cell Carcinoma—Pathogenesis and Potential Implications as Clinical Biomarkers

“…The early diagnosis of RCC still remains difficult due to the lack of broad screening programs and a specific panel of symptoms already noticeable at early-stage disease. Many patients are diagnosed incidentally when they present with symptoms like hematuria, abdominal mass, or flank pain (Vasudev et al, 2020).…”

“…The early diagnosis of RCC still remains difficult due to the lack of broad screening programs and a specific panel of symptoms already noticeable at early-stage disease. Many patients are diagnosed incidentally when they present with symptoms like hematuria, abdominal mass, or flank pain ( Vasudev et al, 2020 ). Since many of these symptoms are non-specific, the majority of patients do not get completely evaluated within the first 6 months after initial presentation ( Zhou et al, 2019a ), thus reducing the number of patients diagnosed at an early stage.…”

Identifying opportunities for timely diagnosis of bladder and renal cancer via abnormal blood tests: a longitudinal linked data study

“… 8 – 10 Renal cancer is one of the cancers with rapidly rising incidence. 11 – 15 With up to 60% of renal cell carcinoma presenting asymptomatically, and given it has been commonly associated with incidental diagnosis in recent decades, 16 understanding the clinical scenarios triggering incidental identification would be useful.…”

Stage–specific incidence trends of renal cancers in the East of England, 1999–2016

“…First, it may represent increasing rates of use of abdominal ultrasounds and CT scans during the study period, and thus rising number of incidental diagnoses [ 24 , 25 ]. Second, it may represent increasingly earlier detection of symptomatic disease, as indicated by decreasing incidence of Stage IV disease, which is least likely to be asymptomatic [ 26 ]. Prospective longitudinal research capturing the symptoms and investigation history of populations of patients diagnosed with renal cancer would be useful in quantifying the degree by which either hypothesis applies.…”