HI Patients with renal cell carcinoma (RCC) can present with a range of symptoms due to the tumor itself (eg, mass, pain), invasion of the urinary tract (eg, hematuria), paraneoplastic syndromes, or the presence of metastases. In addition, RCC is more frequently being diagnosed incidentally as a consequence of increased use of imaging procedures for other reasons. signs, or other findings suggestive of RCC should undergo evaluation for the presence of a renal mass. Ultrasound and CT can confirm the presence of a mass, distinguish RCC from a benign cyst, and assess the extent of disease. Even in the absence of abnormalities suggesting malignancy, imaging studies cannot reliably distinguish a benign renal tumor from an RCC. Thus it is generally recommended that lesions other than simple cysts be resected. The TNM staging system, which is based upon the extent of the primary tumor and the presence or absence of regional lymph node involvement or distant metastases, is preferred (table 2). This staging system correlates with prognosis, and provides important information for patient management. Individuals thought to be at increased risk for the development of RCC should be considered for routine screening with abdominal ultrasound, CT, or MRI. For patients presenting with renal cell carcinoma (RCC), the tumor node metastasis staging system provides the primary prognostic information For patients with metastatic (stage IV) disease, multiple clinical parameters have been identified that are associated with prognosis. These include a poor performance status, an elevated serum lactic dehydrogenase (LDH), and elevated serum calcium, anemia, and the presence of metastatic disease at the initial presentation.