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NCCN Guidelines for Patients



Kidney Cancer, Version 1.2017


Treatment guide

Stage IV and relapsed kidney cancer

Your doctor will decide which treatment to start

with. Before making a treatment plan, he or she will

consider things specific to you. This may include

how you responded to other treatment and how the

cancer is behaving. It is helpful to ask questions

about your treatment options and possible side


Supportive care

Supportive care is recommended along with first-

line treatment for all patients. Supportive care is

treatment given to relieve the symptoms of cancer or

side effects of cancer treatment. It aims to improve

quality of life and relieve any discomfort you may


Supportive care may include radiation therapy,

surgery, drugs, or other treatments. Radiation

therapy may be used to relieve pain from cancer

that has spread to your bones or brain. Drugs that

strengthen your bones may also help with pain and

other problems caused by bone metastases.

Surgery to remove the primary tumor may be used

to ease symptoms like pain or blood in the urine.

Surgery to remove metastases may also help relieve

symptoms. See page 39 for more details about

supportive care.

Guide 9

shows the follow-up tests that are

recommended during and after treatment with

drugs. These tests are also recommended after

a nephrectomy and metastasectomy for stage IV

kidney cancer.

Follow-up tests are used to monitor your health and

check how well treatment is working. An outcome

or improvement related to treatment is called a

treatment response. 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 your kidney

function and watch for treatment side effects. Many

of the tests used for diagnosis and staging are

repeated during follow-up.

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. Some key factors

are your overall health, the extent of the cancer,

and the type of drug you receive. You may need

more or less frequent testing than someone else.

For example, if you are receiving systemic therapy

you may be seen by a doctor and have imaging

tests every 6 to 16 weeks. How often tests are done

may change over time. This may be due to changes

in cancer growth, response to treatment, or other


Regular medical history check-ups, physical exams,

and blood tests will tell your doctor about your

general health. Blood chemistry tests will also show

if your organs, such as your liver and kidneys, are

working well. Abnormal results may be a sign that

an organ isn’t working well. Abnormal results may be

caused by the cancer, treatment, or another health


Certain blood tests may be needed more often based

on the type of drug given. For example, blood tests to

check liver function may be needed more often if you

receive pazopanib. This is because pazopanib can

cause much damage to your liver. Other blood tests

may be needed to watch for certain side effects of

other drugs.

Imaging tests of your chest, abdomen, and pelvis are

an important part of follow-up. Each type of imaging

test works in a slightly different way. These tests help

your doctors watch for any changes in the cancer

size or location during treatment.