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51

NCCN Guidelines for Patients

®

:

Kidney Cancer, Version 1.2017

5

Treatment guide

Stage IV and relapsed kidney cancer

Stage IV and relapsed kidney cancer

Guide 7

shows the primary treatment options

that are recommended for stage IV kidney cancer.

Stage IV kidney cancer is when the tumor has grown

outside the kidney and Gerota’s fascia, cancer has

spread to a distant site, or both.

Primary treatment is the main treatment used to rid

the body of cancer. There are three main treatment

options to choose from. Which primary treatment

option is best for you depends on a number of

factors. One important factor is the size and extent

of the primary tumor. Another important factor is the

number of metastases.

Your doctor will assess the size and extent of the

primary tumor to decide if it can likely be removed

by surgery. If the entire primary tumor can’t be

removed by surgery, then treatment with drugs is

recommended. If the entire primary tumor can be

removed by surgery, then the treatment options

depend on the number of metastases.

If there is only one metastasis, then surgery to

remove the primary tumor and the metastasis is

recommended. A nephrectomy is surgery to remove

the whole kidney with the tumor.

A metastasectomy is surgery to remove the

metastasis. These surgeries may be done at the

same time or during different operations. Other

nearby tissues may also be removed during the

nephrectomy. How much tissue is removed depends

on the extent of the primary tumor. But, this may

not be a good option for everyone. Your doctor will

consider factors like your general health and ability

to do daily activities. This is to make sure you are

healthy enough to have surgery. Your doctor will also

look at the location of the metastasis to decide if it

can be safely removed.

Next steps

If you had a cytoreductive nephrectomy or surgery

wasn’t possible, see Guide 8 for recommended

drug treatments. If you had a nephrectomy and

metastasectomy, see Guide 9 on page 55 for

recommended follow-up tests.

Guide 7. Primary treatment

Test results

Primary treatment options

Primary tumor can likely be removed by surgery +

only one metastasis

• Nephrectomy + metastasectomy

Primary tumor can likely be removed by surgery +

many metastases

• Cytoreductive nephrectomy (certain patients) prior to

treatment with drugs

Primary tumor can’t be removed by surgery

• Treatment with drugs