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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Overview of cancer treatments

Surgery | Active surveillance

Before the surgery, you will be asked to stop eating,

drinking, and taking some medications for a short

period of time. If you smoke, it is important to stop.

This surgery is done under general anesthesia—a

controlled loss of wakefulness from drugs. There is

more than one way to perform a radical nephrectomy.

The surgery methods that may be used are

described on page 31.

Risks and side effects of radical nephrectomy

With any type of surgery, there are some health

risks and side effects. A side effect is an unhealthy

or unpleasant condition caused by treatment. Some

possible side effects of a radical nephrectomy include

infections, bleeding, pain from the surgical cuts, and

reduced kidney function. Since the whole kidney

is removed, this surgery also increases the risk for

chronic kidney disease. Chronic kidney disease is

when kidney function slowly gets worse over a long

period of time.

Cytoreductive nephrectomy

A cytoreductive nephrectomy is surgery to remove

the whole kidney with the primary tumor in the

presence of metastatic disease. Metastatic means

the cancer has spread from where it first formed to

another partof the body and formed new tumors.

New tumors that formed far from the primary tumor

are called metastases. It isn’t possible to remove all

of the cancer from your body with surgery when there

are many metastases. But, removing at least some of

the cancer can still be helpful for some patients.

The goal of cytoreductive surgery is to reduce the

amount of cancer in your body. This surgery may be

used for patients who have many metastases if the

primary tumor can be completely removed. Some

patients may benefit from having a cytoreductive

nephrectomy before treatment with drugs. Removing

the primary tumor may improve how well other

treatments work against the remaining cancer and



A metastasectomy is surgery to remove

metastases—tumors that formed from cancer that

spread from

the first tumor. This surgery may be

used when the primary tumor can be completely

removed and there is only one metastasis. But, not

all metastases can be removed by surgery. The

location is a key factor. This approach works best for

metastases in the brain, bone, or lung.

A metastasectomy may be done at the same time

as surgery to remove the primary tumor. Or, it may

be done during a separate operation. The amount of

time needed for the surgery and recovery depends

on many factors. Some factors include the size and

location of the metastasis.

Active surveillance

Active surveillance consists of testing on a regular

basis to watch for tumor growth so that treatment can

be started later, if needed, instead of right away. This

may be used for certain patients with a very small

tumor (3 cm or smaller) that is only in the kidney.

Active surveillance may be an option for patients who

are elderly or have other serious health problems.

Such patients may not be healthy enough for surgery

or other cancer treatments. Also, the cancer may not

pose the greatest risk to their health.

All cancer treatments have some health risks and

side effects. Older age and having other health

problems increases the risk of severe side effects

and complications. For these patients, the potential

risks of treatment may be more dangerous than the