What are the current guidelines for the management of localized renal cell carcinoma in primary care?

In primary care, the management of localized renal cell carcinoma (RCC) primarily involves early detection, appropriate referral, and supportive care rather than definitive treatment, which is undertaken in specialist settings. Patients suspected of having localized RCC should be promptly referred to a urology or oncology specialist for further diagnostic imaging and staging, as primary care does not provide curative interventions for RCC NICE CKS.

Initial suspicion may arise from incidental findings on imaging or clinical presentations such as haematuria or flank pain, but definitive diagnosis and staging require specialist imaging modalities like contrast-enhanced CT or MRI, which are beyond primary care capabilities Berquist et al. 2019. Primary care clinicians should focus on optimizing the patient's general health, managing comorbidities, and providing information and support while awaiting specialist assessment.

Once referred, treatment options for localized RCC typically include surgical resection (partial or radical nephrectomy) or, in selected cases, ablative therapies. Systemic therapies are generally reserved for advanced or metastatic disease but are evolving with ongoing research Berquist et al. 2019. Primary care's role includes monitoring for treatment side effects, supporting recovery, and coordinating follow-up care in collaboration with specialists.

There are no specific UK NICE guidelines detailing primary care management protocols for localized RCC, reflecting the specialist nature of treatment. However, good practice includes ensuring timely referral, patient education about the disease and treatment pathway, and managing comorbid conditions such as hypertension or chronic kidney disease that may impact treatment outcomes NICE CKS.