The “classic triad” of kidney cancer

The “classic triad” of kidney cancer: early diagnostic of renal cell carcinoma symptoms

Kidney cancer incidence rates in the United States have risen dramatically since the 1950s. They have risen over 126 percent, translating into over 30,000 new cases a year. Death rates have risen by 36.5 percent, causing approximately 11,900 deaths a year.

The rise in incidence rates may be explained at least in part by better diagnostic tools: thanks to CT scans, ultrasounds, and other tools, kidney cancer is diagnosed with greater frequency than it was in the past. Early detection of the disease has also helped improve five-year survival rates. While the 1950s saw average survival rates of 34 percent, by 1996 the average five-year survival rate had risen to 62 percent.

Kidney cancer statistics:

– It makes up three percent of all cancer cases.

– It’s the eighth most common malignancy in men.

– It’s the tenth most common malignancy in women.

Renal cell carcinoma is the most common of all possible renal neoplasms. It is quite difficult to identify this type of cancer: in some patients, the symptoms may be mild or absent altogether.

Kidney cancer symptoms develop as the disease progresses.

Explaining the Classic Triad

Three conditions make up the “classic triad” of kidney cancer. Hematuria is the most common. Hematuria is the presence of blood in the urine. Often, the blood can be seen with the naked eye (a condition called gross hematuria). Blood may also be present in microscopic amounts, detectable only by urinalysis. Hematuria occurs in sixty percent of patients.

Pain is a symptom in 40 percent of cases. The pain is felt in the lower back, just below the ribs, and is constant. Finally, in 30 to 40 percent of cases, a palpable mass may be detected during a routine physical examination of the kidneys.

Although the combination of hematuria, pain, and a palpable mass is referred to as the classic triad, in reality only ten percent of patients present with all three conditions. The presence of the classic triad usually indicates a well-advanced tumor.

Other symptoms of renal cell carcinoma often appear when the disease is more advanced, but no single individual experiences all possible RCC symptoms. Anemia, or a lack of red blood cells, may occur. Weight loss, fatigue, fevers, and night sweats are also common. Men may experience varicocele: varicose veins that affect the testes.

Erythropoietin and polycythemia

Some RCC tumors produce excessive amounts of erythropoietin, a hormone that stimulates the production of red blood cells. Excessive amounts of erythropoietin lead to polycythemia, an overabundance of red blood cells. Polycythemia may cause headaches, dizziness, vein inflammation, breathing difficulties, itchiness, and a feeling of abdominal fullness. Patients may also experience unusual redness of the skin, especially in facial skin.

Parathyroid hormone and Hypercalcemia

RCC tumors can also produce parathyroid hormone, a hormone usually produced by the parathyroid gland. Too much parathyroid hormone production can lead to hypercalcemia, an excessive amount of calcium in the blood. Hypercalcemia may present asymptomatically. If symptoms do occur, they can include the following:

– tiredness;

– a lack of appetite;

– pain;

– frequent urination;

– thirst;

– nausea;

– vomiting;

– difficulty thinking;

– constipation.

CT scan, intravenous pyelogram, and other tools for the early diagnostic

Renal cell carcinoma is often detected incidentally: a routine x-ray reveals that the kidney is enlarged. From there, further testing is required to confirm the diagnosis. Once a diagnosis is made, the cancer is staged to determine how advanced the tumor is. The stage assigned to a tumor often includes survival statistics.

– Physical exam. Diagnosis usually begins with a physical exam. Your doctor palpates the area around the kidney, checking for signs of unusual growth or firmness. The doctor will ask a number of questions about your medical history, exposure to substances that can cause cancer, and your lifestyle. Blood and urine tests may also be ordered.

If your physical exam leads your doctor to suspect cancer, further testing will be ordered. Diagnostic tools such as an ultrasound or IVP are used to determine the presence and size of a tumor.

– An ultrasound uses high-frequency sound waves to generate a picture of the kidney. An ultrasound is non-invasive, has few if any side effects, and generates an image that can provide information about the size and density of any suspicious areas of the organ. As such, ultrasound is one of the most common diagnostic tests ordered for renal cell carcinoma.

– An intravenous pyelogram, or IVP, is also a common choice when diagnosing kidney cancer. The soft tissues of the kidneys, ureters, and bladder are often indistinguishable from other abdominal features, so a dye is useful in highlighting these areas as it flows through the kidneys. The iodine-based dye is injected into the body through a vein. The dye makes its way through the blood, eventually being removed by the kidneys, and passing through the ureters and bladder. The IVP is actually a series of x-rays that constructs a picture of the dye as it passes through these organs. Abnormal growths can then be seen on the x-ray films.

– Arteriography. Veins and arteries are normally not visible in an x-ray, so arteriography, like IVP, uses dye to highlight these features on an x-ray. The dye in the arteriography is injected locally using a catheter, allowing a greater concentration of dye and a high-resolution image. This is also known as a renal angiogram. Similarly, a renal venogram can be performed by placing the catheter into the renal vein and injecting the dye there.

– A computed tomography, or CT scan, offers detailed images of internal organs. A CT scan takes a series of x-rays, each photographing a “slice” of the kidney. These “slices” are combined using a computer to generate a 3-dimensional image of the organ. Because the procedure is so detailed, a CT scan is often used to determine the possible spread of the disease to other organs.

– Biopsy. Although diagnostic tools such as ultrasound and IVP can reveal the presence of a tumor, a biopsy is the only way to determine with accuracy whether the growth is malignant or not. A needle is inserted into the tumor, and a sample of the tissue is removed. The sample is then examined microscopically for signs of cancer.


The article is written by licensed urologists: Dr. David M. Kaufman and David M. Weiner, MD. If you have any questions after reading the article, you can contact us by asking a question in the feedback form

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