Authors: M. C. Smaldone;  D. Canter;  J. Simhan;  A. Kutikov;  R. G. Uzzo *
Authors‘ workplace: Department of Surgery, Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania *
Published in: Urol List 2012; 10(1): 26-30


With the continued, routine use of cross-sectional imaging for unrelated reasons, the incidental diagnosis of small renal masses (< 4 cm) continues to rise. Yet, despite this fact, the overall mortality rate for renal cell carcinoma remains unchanged. Active surveillance of small renal masses has emerged as a viable option for patients, especially those who are older and/or co-morbid. In this article, we review the existing world literature regarding small renal masses with specific interest in growth kinetics and rates of progression/metastases.

Key words:
renal cell carcinoma, small renal mass, active surveillance


1. Jemal A, Siegel R, Xu J et al. Cancer statistics, 2010. CA Cancer J Clin 2010; 60(5): 277–300.

2. Chow WH, Devesa SS, Warren JL et al. Rising incidence of renal cell cancer in the United States. JAMA 1999; 281(17): 1628–1631.

3. Hollingsworth JM, Miller DC, Daignault S et al. Rising incidence of small renal masses: a need to reassess treatment effect. J Natl Cancer Inst 2006; 98(18): 1331–1334.

4. Jayson M, Sanders H. Increased incidence of seren­dipitously discovered renal cell carcinoma. Urology 1998; 51(2): 203–205.

5. Crispen PL, Viterbo R, Boorjian SA et al. Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer 2009; 115(13): 2844–2852.

6. Letourneau I, Ouimet D, Dumont M et al. Renal replacement in end-stage renal disease patients over 75 years old. Am J Nephrol 2003; 23(2): 71–77.

7. Go AS, Chertow GM, Fan D et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351(13): 1296–1305.

8. Campbell SC, Novick AC, Belldegrun A et al. Guide­line for management of the clinical T1 renal mass. J Urol. 2009; 182(4): 1271–1279.

9. Hollingsworth JM, Miller DC, Daignault S et al. Five-year survival after surgical treatment for kidney cancer: a population-based competing risk analysis. Cancer 2007; 109(9): 1763–1768.

10. Kutikov A, Egleston BL, Wong YN et al. Evaluating overall survival and competing risks of death in patients with localized renal cell carcinoma using a comprehensive nomogram. J Clin Oncol 2010; 28(2): 311–317.

11. Lane BR, Samplaski MK, Herts BR et al. Renal mass biopsy--a renaissance? J Urol 2008; 179(1): 20–27.

12. Wang R, Wolf JS Jr., Wood DP Jr. et al. Accuracy of percutaneous core biopsy in management of small renal masses. Urology 2009; 73(3): 586–590.

13. Rothman J, Crispen PL, Wong YN et al. Pathologic concordance of sporadic synchronous bilateral renal masses. Urology 2008; 72(1): 138–142.

14. Schachter LR, Bach AM, Snyder ME et al. The impact of tumour location on the histological subtype of renal cortical tumours. BJU Int 2006; 98(1): 63–66.

15. Venkatesh R, Weld K, Ames CD et al. Laparo­scopic partial nephrectomy for renal masses: effect of tumor location. Urology 2006; 67(6): 1169–1174.

16. Weizer AZ, Gilbert SM, Roberts WW et al. Tailoring technique of laparoscopic partial nephrectomy to tu­mor characteristics. J Urol 2008; 180(4): 1273–1278.

17. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009; 182(3): 844–853.

18. Ficarra V, Novara G, Secco S et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 2009; 56(5): 786–793.

19. Simmons MN, Ching CB, Samplaski MK et al. Kidney tumor location measurement using the C index method. J Urol 2010; 183(5): 1708–1713.

20. Kutikov A, Manley BJ, Canter DJ et al. Anatomical features of enhancing renal masses predict histology and grade – an analysis using nephrometry (AUA abstract no. 1238). J Urol 2010; 183(4): e479.

21. Chawla SN, Crispen PL, Hanlon AL et al. The na­tural history of observed enhancing renal masses: meta-analysis and review of the world literature. J Urol 2006; 175(2): 425–431.

22. Smaldone MC, Kutikov A, Canter DJ et al. A Critical Analysis of Active Surveillance with Delayed Curative Intent for the Treatment of Small Renal Masses. Podium presentation (#11); presented at the Society of Urologic Oncology. 2010.

23. Fujimoto N, Sugita A, Terasawa Y et al. Obser­vations on the growth rate of renal cell carcinoma. Int J Urol 1995; 2(2): 71–76.

24. Kato M, Suzuki T, Suzuki Y et al. Natural history of small renal cell carcinoma: evaluation of growth rate, histological grade, cell proliferation and apoptosis. J Urol 2004; 172(3): 863–866.

25. Bosniak MA, Birnbaum BA, Krinsky GA et al. Small renal parenchymal neoplasms: further observations on growth. Radiology 1995; 197(3): 589–597.

26. Abou Youssif T, Kassouf W, Steinberg J et al. Active surveillance for selected patients with renal masses: updated results with long-term follow-up. Cancer 2007; 110(5): 1010–1014.

27. Beisland C, Hjelle KM, Reisaeter LA et al. Obser­va­tion should be considered as an alternative in ma­na­gement of renal masses in older and comorbid patients. Eur Urol 2009; 55(6): 1419–1427.

28. Fernando HS, Duvuru S, Hawkyard SJ. Conser­va­tive management of renal masses in the elderly: our experience. Int Urol Nephrol 2007; 39(1): 203–207.

29. Kouba E, Smith A, McRackan D et al. Watchful waiting for solid renal masses: insight into the natural history and results of delayed intervention. J Urol 2007; 177(2): 466–470.

30. Lamb GW, Bromwich EJ, Vasey P et al. Mana­ge­ment of renal masses in patients medically unsui­table for nephrectomy--natural history, complications, and outcome. Urology 2004; 64(5): 909–913.

31. Matsuzaki M, Kawano Y, Morikawa H et al. Con­ser­vative management of small renal tumors. Hinyokika Kiyo 2007; 53(4): 207–211.

32. Siu W, Hafez KS, Johnston WK 3rd et al. Growth rates of renal cell carcinoma and oncocytoma under surveillance are similar. Urol Oncol 2007; 25(2): 115–119.

33. Sowery RD, Siemens DR. Growth characteristics of renal cortical tumors in patients managed by watchful waiting. Can J Urol 2004; 11(5): 2407–2410.

34. Volpe A, Panzarella T, Rendon RA et al. The natural history of incidentally detected small renal masses. Cancer. 2004; 100(4): 738–745.

35. Wehle MJ, Thiel DD, Petrou SP et al. Conservative management of incidental contrast-enhancing renal mas­ses as safe alternative to invasive therapy. Urology 2004; 64(1): 49–52.

36. Rosales JC, Haramis G, Moreno J et al. Active surveillance for renal cortical neoplasms. J Urol 2010; 183(5): 1698–1702.

37. Wong JA, Rendon RA. Progression to metastatic disease from a small renal cell carcinoma prospectively followed with an active surveillance protocol. Can Urol Assoc J 2007; 1(2): 120–122.

38. Jewett MA, Finelli A, Morash C et al. Active Survei­llance of Small Renal Masses: A Prospective Multi-Center Canadian Uro-Oncology Group Trial: Abstract No. 896. J Urol 2009; 181 (4 Suppl): 320.

39. Abouassaly R, Lane BR, Novick AC. Active surveillance of renal masses in elderly patients. J Urol 2008; 180(2): 505–508.

Paediatric urologist Urology

Article was published in

Urological Journal

Issue 1

2012 Issue 1

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account