Renal Cell Carcinoma
Choosing the best treatment plan for RCC involves considering the results of staging procedures and other tests. And even after a plan has been established, it may change based on further testing. For example, if the pathologist finds cancer cells in the lymph nodes or the surgical margins, you may need additional treatment. Or if your doctor determines that your kidney function is poor, the scheduled treatment may need to change because some types of treatment may no longer be appropriate.
The options listed here by stage provide basic information about how your cancer may be treated. Many other details are involved, though, so make sure you discuss them with your treatment team.
Surgery by partial nephrectomy is usually the primary treatment for Stage IA RCC. If a partial nephrectomy is not possible because of the tumor’s location or other factors, a radical nephrectomy is the most common alternative. Ablative techniques are also an option, but they have been associated with a higher risk of the cancer coming back. Treatment given in addition to the primary treatment (known as adjuvant therapy) has currently not shown any benefit, so in most cases, no further therapy is given after surgery.
Surgery by either a partial or radical nephrectomy is the standard of care for the treatment of Stage IB tumors. Partial nephrectomies are the preference whenever feasible, and in most cases, no further therapy is given after surgery.
Stage II and III
Surgery by partial nephrectomy is usually not an option at these stages because the tumors of this size may have extended into the inferior vena cava, so a radical nephrectomy is the standard of care. Again, most patients receive no further therapy after the surgery.
Stage IV (metastatic RCC)
The most common site of RCC metastasis is the lung, but spread to the lymph nodes, bone, brain, liver or adrenal glands is also common. Surgery may be appropriate for patients with primary Stage IV RCC and a single metastatic site and for patients who develop a single recurrence of RCC a number of years after their original nephrectomy. In other patients with Stage IV disease, surgery to reduce the size of the tumor(s) is generally recommended, but it is not appropriate for everyone. Targeted and biological therapies are additional options for treating Stage IV RCC, either with or without surgery.
Recurrent disease after surgery
Approximately 20 to 30 percent of patients with Stage I, II or III tumors that have been surgically removed experience a return of their RCC, generally anywhere from one to three years after surgery. This recurrence may happen at a local site in the kidney or at a distant site in the body. If the cancer recurs in the kidney and is considered resectable, another surgical nephrectomy may be done, assuming enough time has passed after the first procedure. If the cancer comes back outside the kidney, the choices are the same as for cancer that is Stage IV at diagnosis.