LAUSR

The clinical presentation of Renal Cell Carcinoma (RCC) has changed dramatically over the last 50 years. In 1981, Hellsten et al. published two papers on a large autopsy series from Malm€ o during the period 1958–69 [1,2]. The main finding was that 235 of 350 RCCs were unrecognized until postmortem. Most of these patients died of old age and comorbidities rather than RCC. Furthermore, in many patients, RCC was found in addition to another malignant tumor causing the death. In 1971, Skinner at al. published a paper demonstrating that only 7% of the diagnosed RCCs were found incidentally [3]. In Norway, we have seen that the fraction of incidentally diagnosed RCCs have increased from 21% in period 1978–87 [4] to 57% in the period 2005–10 [5]. The most obvious reason for this is the more widespread use of imaging. Sand et al. [5] showed that 2/3 of the incidental RCCs were found during follow-up for comorbidities and that these patients were more likely to die of these conditions than of RCC (i.e. other malignancies). In general, the incidence of RCC is increasing in the industrialized world. This might be in part due to more obesity and other known risk factors. However, it is nice to think that we today diagnose tumors in living patients that earlier would have died with unrecognized RCCs. As a result of this, urologists today face more and smaller tumors in an older and more comorbid patient population. Therefore, how to manage these incidentally detected small renal masses are among hottest topics in contemporary urology with separate guidelines being published [6].