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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Treatment guide

Stage I kidney cancer

When only part of the kidney is removed, more

kidney function is preserved. Thus, this surgery is

ideal for patients who have only one kidney, poor

kidney function, or tumors in both kidneys.

But, sometimes a partial nephrectomy can’t be done.

This may be because the tumor is near the middle

of the kidney or very close to major veins. If a partial

nephrectomy can’t be done, then another option is to

have a radical nephrectomy. A radical nephrectomy

is surgery that removes the whole kidney with the

tumor. This surgery may also remove the attached

adrenal gland and nearby lymph nodes. How much

tissue is removed depends on the extent of the


Surgery may not be a good treatment option for

everyone. Your doctor will look at many factors to

decide if you are healthy enough to have surgery.

Such factors include your age, general health, other

current health problems, and how well your lungs,

heart, and other organs are working. Based on

these and other factors, your doctor may decide that

surgery isn’t a good option for you.

Besides surgery, there are two other primary

treatment options for very small tumors. One option

is active surveillance. Active surveillance consists

of testing on a regular basis to watch for tumor

growth. Treatment may be started later if needed,

based on the results of tests, instead of right away.

This may be a good option if you are elderly or have

other serious health conditions. Both are factors that

increase the risk of serious problems during and after


Thermal ablation is another option for certain patients

with a T1 tumor. Thermal ablation uses extreme heat

or extreme cold to destroy small tumors. This type

of treatment causes very little damage to nearby

tissues. It is much less invasive and has fewer side

effects than surgery.

For stage I (T1b),

surgery is used as primary

treatment. You may have a partial or radical

nephrectomy, as described above. Your doctor

will consider a number of factors to help decide

which type of surgery is best for you. Such factors

include your general health, how well your kidneys

are working, and the size, location, and extent of

the tumor. NCCN experts recommend that a partial

nephrectomy should always be used when possible.

But, sometimes a partial nephrectomy can’t be done.

This may be because the tumor is larger in size, near

the middle of the kidney, or very close to major veins.

In such cases, a radical nephrectomy may be the

best option.

Next steps

After primary treatment for stage I kidney cancer,

you will begin follow-up testing. For recommended

testing during active surveillance, see Guide 4. If you

had a partial nephrectomy, a radical nephrectomy,

or thermal ablation, see Guide 5 for recommended

follow-up tests.