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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Treatment guide

Stage I kidney cancer

Guide 4

shows the tests that are recommended

during active surveillance for tumors 4 cm or smaller.

Active surveillance consists of frequent testing on

an ongoing basis to watch for tumor growth. Many of

the tests used for diagnosis and cancer staging are

repeated during active surveillance.

But, no single follow-up plan is right for all patients.

The tests and schedule should be tailored for each

patient. You may need more or less frequent testing

than someone else. The timing and duration of

follow-up testing should be based on factors specific

to you. Such factors include your age, general health,

the tumor size, and the tumor location.

You will have a number of different tests to monitor

the cancer so that treatment can be started when, or

if, needed. The medical history, physical exam, and

blood tests will tell your doctor about your overall

health. Blood chemistry tests will also show if your

organs, such as your liver and kidneys, are working


Imaging tests of your abdomen are used to check if

and how much the tumor grows over time. The first

few imaging tests will help your doctor assess the

growth rate. The growth rate is a measure of how

much the cancer grows over a set period of time.

Ongoing imaging tests are used to watch the growth

rate to see if anything changes.

Guide 4. Testing during active surveillance

Follow-up tests


Medical history and physical exam

• Every 6 months for 2 years, then once a year for up to

5 years after diagnosis

Blood chemistry panel and other blood tests

• Every 6 months for 2 years, then once a year for up to

5 years after diagnosis

Imaging tests of the abdomen

• CT or MRI within 6 months of starting surveillance, then

CT, MRI, or ultrasound at least once a year

Imaging tests of the chest

• X-ray or CT once a year, if cancer confirmed by biopsy

CT or MRI of the pelvis

• As needed

CT or MRI of the head or MRI of the spine

• As needed

Bone scan

• As needed