Symptoms of kidney cancer may vary from the classic triad (haematuria, pain in the flank and a palpable mass on one side), non-characteristic symptoms, to random findings from a scan (ultrasound, CT, or MRI) carried out for another reason. The classic triad is seen in only about 10% of patients.

• As a result of increased availability of scanners, the proportion of patients in whom kidney cancer is found randomly has increased significantly and now accounts for approximately 45% of all cases
• Macro- or microscopic haematuria should always be investigated further
• Flank pain
• Palpable mass on one side
• Varicocele – especially on the right side – may be a sign of kidney cancer with tumour thrombus, obstructing vena spermatica interna
• Non-characteristic symptoms such as increased tiredness, weight loss without obvious cause, night sweats, fever and/or persistent abnormal blood tests (high CRP, low haemoglobin, elevated liver counts)
• Overproduction of a number of hormones that can cause paraneoplastic syndromes and also explain some of the uncharacteristic symptoms as described above
  • hypercalcaemia (due to secretion of peptides with PTH effect)
  • high haemoglobin – polycythaemia (increased secretion of EPO)
  • elevated BP (due to hypersecretion of renin)
• Pain in back, hip, extremities, thoracic wall can be observed in bone metastases
• Neurological symptoms and/or headaches may be observed in cerebral metastases or hypercalcaemia
• Cough and dyspnoea can be observed in lung metastases

1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) – Kidney Cancer. NCCN.2018
2. ESMO guidelines 2019
3. EAU guidelines 2017
4. DaRenCa guidelines