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 recognition, appropriate referral, and supportive care rather than definitive treatment, which is undertaken in specialist settings. Localized RCC is typically managed by urology or oncology specialists following diagnosis, with primary care playing a key role in initial detection and ongoing patient support.

Initial management in primary care includes prompt investigation of symptoms suggestive of RCC such as haematuria, flank pain, or an abdominal mass, and referral for imaging (usually ultrasound or CT) to confirm diagnosis. Once localized RCC is suspected or diagnosed, urgent referral to a specialist multidisciplinary team is essential for staging and treatment planning, as curative options such as partial or radical nephrectomy or ablative therapies are performed in secondary care NICE CKS.

Role of primary care after diagnosis involves supporting the patient through the diagnostic and treatment pathway, managing comorbidities, and providing lifestyle advice to optimize overall health. Primary care clinicians should also monitor for and manage treatment-related complications and coordinate care with specialists.

Systemic therapy is generally reserved for locally advanced or metastatic RCC and is not initiated in primary care. However, awareness of emerging systemic therapies and their side effects is important for primary care clinicians to provide holistic care and timely referral back to oncology if complications arise Berquist et al. 2019.

In summary, current UK guidelines and expert literature emphasize that localized RCC management is specialist-led, with primary care focused on early detection, referral, and supportive care rather than direct oncological treatment NICE CKS Berquist et al. 2019.