The clinical manifestations of patients with renal cell carcinoma are complex and variable. Some of these clinical manifestations are a direct result of the renal tumor itself, while others may be due to hormones secreted by the cancer cells or metastases. Due to the increasing popularity of health checkups, most patients who come to hospitals with renal cell carcinoma are usually discovered inadvertently by imaging.
In clinical practice, early stage renal cell carcinoma often lacks clinical manifestations. When the classic triad of renal cell carcinoma (hematuria, lumbar pain and abdominal mass) is present, most of the patients are already in the middle and advanced stages; when left spermatic varices are present, it indicates the possible combination of left renal vein thrombosis; therefore, early diagnosis of renal cell carcinoma is of great importance.
Paraneoplastic syndrome: The clinical manifestation is not directly caused by the primary tumor or metastasis site, but indirectly caused by the abnormal immune reaction or other unknown causes of endocrine, neurological, digestive, hematopoietic, bone and joint, renal and skin systems, and the corresponding clinical manifestation is called paraneoplastic syndrome. The incidence of paraneoplastic syndrome in patients with renal cell carcinoma is about 30%, which is characterized by hypertension, increased erythrocyte sedimentation rate, erythrocytosis, abnormal liver function, hypercalcemia, hyperglycemia, neuromuscular lesions, amyloidosis, overflow, and abnormal coagulation mechanism. The prognosis of patients who present with paraneoplastic syndrome is worse.
Symptoms caused by metastatic foci: Some patients with renal cell carcinoma present with clinical manifestations of metastatic foci as their first symptoms, such as bone pain, fracture, cough, hemoptysis, etc. Physical examination findings include enlarged lymph nodes in the neck, secondary varicose veins and bilateral lower limbs edema, the latter suggesting possible tumor invasion of renal veins and inferior vena cava. Among patients with metastatic renal cell carcinoma, the common metastatic organs and the incidence of metastases were, in order, lung metastases (48.4%), bone metastases (23.2%), liver metastases (12.9%), adrenal metastases (5.2%), skin metastases (1.9%), brain metastases (1.3%), other sites, etc. (7.1%). Patients with advanced disease may also show symptoms of malignancy such as wasting, weakness, and poor nausea.