Stanley A. Yap,¹ Shabbir M.H. Alibhai,^2,3Antonio Finelli,^1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. ²Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. ³Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract
The incidence of small renal masses (SRMs) has risen steadily over time, and SRMs now represent the majority of newly diagnosed renal lesions. Approximately 80% of newly diagnosed SRMs will be malignant. However, identifying a benign versus malignant lesion non-invasively can be difficult since no distinct imaging characteristics or growth patterns exist between the two. We have witnessed concurrent improvements in treatment strategies for small, localized tumors and have gained a better understanding of their natural history. Along with these changes there has been a shift in the manner in which we diagnose and treat SRMs. Although surgery remains the standard of care, we can now offer a variety of therapies individualized to the patient.
Keywords: kidney cancer, small renal mass, diagnosis, treatment.

Christina M. Canil, MD, FRCPC, Clinical Research Fellow and Jennifer J. Knox, MD, MSc, FRCPC, Staff Medical Oncologist; Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, Toronto, ON.

Renal cell carcinoma is more prevalent in older people. The incidence of this cancer is rising secondary to incidental detection on routine imaging. In localized disease, radical nephrectomy is standard therapy; however, options of laparoscopic procedures or surveillance may be appropriate for small tumours. Treatment of advanced or metastatic renal cell carcinoma is limited and the main goal of therapy is palliation of symptoms. Nephrectomy and surgical removal of metastases have been shown to improve survival in patients with good performance status. Results with chemotherapy have been disappointing, but clinical trials of novel systemic agents are underway.
Key words: renal cell carcinoma, kidney cancer, older person, nephrectomy, interferon.