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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Treatment guide

Stages II and III kidney cancer

The healthy part of your kidney and the nearby

tissues are left in your body. A partial nephrectomy

may only be an option for some patients with this

stage II or stage III kidney cancer.

Follow-up tests

After primary treatment, you will begin follow-up

testing. Follow-up tests are used to monitor your

health after treatment. Doctors use follow-up tests to

look for signs of cancer return or spread (metastasis)

after treatment. The return of cancer after treatment

is called a relapse or recurrence. Follow-up tests

are also used to check that your remaining kidney

and other organs are working well. Many of the tests

used for diagnosis and staging are repeated during


No single follow-up plan is right for all patients.

Your doctor will adjust the follow-up plan based on

a number of factors specific to you and the tumor.

Some key factors are the type of treatment you

had, the size and extent of the tumor, and your

overall health. You may need more or less frequent

testing than someone else. The timing and duration

of follow-up testing should be based on the risk of

recurrence and other factors specific to you. Follow-

up testing may be extended beyond 5 years as your

doctor sees fit.

Medical history check-ups and physical exams will

tell your doctor about your general health. You will

also have blood tests and imaging regularly for up to

5 years after a nephrectomy. Monitoring the health

of your remaining kidney is very important. Poor

kidney function can increase the risk of other health

problems. Abnormal results of blood chemistry tests

may be a sign of organ damage. Abnormal results

may also be a sign that the cancer has come back or

spread to other parts of your body.

Imaging tests of your abdomen are used to check for

signs of local recurrence. A local recurrence is when

cancer comes back in or near the same place as the

primary tumor. A baseline CT or MRI scan of your

abdomen should be done within 3 to 6 months after

surgery. A baseline test is a starting point to which

future tests are compared. Imaging tests of your

abdomen are recommended on a regular basis for

up to 5 years. After 5 years, further testing may be

done as needed. Imaging tests may also be done to

check out signs or symptoms in a certain part of your

abdomen. This is called site-specific imaging.

Imaging tests of your chest are important since

the lungs are the most common site of distant

recurrence. An x-ray or CT scan of your chest will

show if cancer has spread to your lungs. A baseline

CT scan of your chest is recommended within 3 to 6

months after surgery. After the baseline test, an x-ray

or CT scan should be done on a frequent basis for

the next few years. After 5 years, imaging tests may

be done as needed based on the risk of recurrence

and other factors specific to you. The cancer stage

and tumor size are two key factors that affect the risk

of recurrence.

Imaging tests of your pelvis, head, spine, and bones

are not recommended as standard follow-up tests

for all patients. These tests may be done as needed

such as if there are signs or symptoms of cancer

spread. A CT or MRI scan of your head may be

done to show if cancer has spread to your brain.

Some symptoms of cancer in the brain are chronic

headaches, seizures, loss of balance, and weakness

on one side of the body. If you have bone pain or

high levels of ALP in your blood, then a bone scan

may be done to show if cancer has spread to your