Researchers who studied renal cell carcinoma (RCC) cases diagnosed between 1964 and 1997 observed an increase in the proportion of cases diagnosed incidentally during that period as well as a decrease in hematuria and elevated erythrocyte sedimentation rate (ESR) as presenting symptoms.

Kaisa L. Sunela, MD, of Tampere University Hospital, and collaborators at the University of Tampere in Tampere, Finland, analyzed the records of 970 patients with 982 RCC tumors. The investigators divided patients in three groups: those diagnosed before 1980, in the 1980s, and in the 1990s. The proportion of RCC cases diagnosed incidentally increased from 12% to 19% during the study period.

Flank pain was the most common symptom for the study population as a whole, occurring in 35% of patients. This proportion did not change significantly during the study period. In cases diagnosed before 1980, hematuria was the most common symptom, occurring in 39% of patients.

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The percentage decreased significantly to 30% in the 1980s and 26% in the 1990s, the authors reported in BJU International (2010;published online ahead of print). Prior to 1980, a high ESR was a symptom in 28% of cases; this percentage rose to 33% in the 1980s, but declined significantly to 20% in the 1990s.

Overall, hematuria occurred more frequently in men than women (36% vs. 23%), whereas more women experienced flank pain (41% vs. 30%). Anemia also was more common in women than men (19% vs. 12%).

Additionally, the researchers observed a significant decline in systemic and chronic symptoms. Systemic and chronic symptoms occurred in 46% and 33% of cases, respectively, before 1980 compared with 40% and 21%, respectively, in the 1990s. The proportion of cases with acute symptoms increased from 28% before 1980 to 49% in the 1990s.

More asymptomatic tumors or tumors with local symptoms only were on the right side than the left side (53% vs. 47%). Systemic symptoms were more commonly associated with left-sided than right-sided tumors (54% vs. 46%).