Epidemiology, clinical staging, and presentation of renal cell carcinoma.

The increasing incidence of renal cell carcinoma over the past 2 decades can be partly explained by the expanding use of abdominal imaging. As a result, the most incident renal cancers today are small, localized, and asymptomatic. However, the well-documented rise in all stages of RCC calls into question the nature of these asymptomatic lesions. The expected "screening effect" of detecting RCC when it is small and localized, with subsequent decreases in disease-specific mortality, has not been observed. Disease-specific mortality is actually rising, especially in African American patients. Effective interventions aimed at reducing obesity, hypertension, and smoking may help in reducing the incidence of RCC in the future.