Renal Cell Carcinoma
Treatment by Stage
Now that you have learned about the treatments available to treat renal cell carcinoma (RCC), you can talk with your doctor about which option may work best for you. Before making a recommendation, your doctor will consider your overall health along with the results of staging procedures and other tests. It’s possible your treatment plan may change, too. For example, if the pathologist finds cancer cells in the lymph nodes or the surgical margins after surgery, you may need additional treatment. Or, if your doctor determines that your kidney function is poor, some types of treatment may no longer be appropriate.
The options listed here by stage provide basic information about how your RCC may be treated. Many other details are involved, so make sure you discuss them with your treatment team.
Stage I
A partial nephrectomy is the preferred treatment for Stage I RCC when the tumor is less than 4 centimeters (about 1.5 inches). If a partial nephrectomy is not possible because of where the tumor is located or other factors, a radical nephrectomy is the most common alternative. Ablative techniques, such as cryotherapy or radiofrequency ablation, are also options for tumors of this size, especially for people who cannot have surgery because of their overall health status. (However, ablative techniques have been associated with a higher risk of the cancer coming back.) A partial or radical nephrectomy is done for larger Stage I tumors (up to 7 centimeters, which is almost 3 inches).
A clinical trial may be an option (see Clinical Trials). Radiation therapy or arterial embolization may be used as palliative therapy or treatment to relieve symptoms.
Stage II
A radical nephrectomy is the standard of care for Stage II tumors. A clinical trial may be an option (see Clinical Trials). Radiation therapy or arterial embolization may be used as palliative therapy.
Stage III
A radical nephrectomy is the standard of care for Stage III tumors. A clinical trial may be an option (see Clinical Trials). Arterial embolization, surgery or radiation therapy may be used as palliative therapy.
Stage IV (Metastatic RCC)
Treatment of Stage IV RCC depends on the number of sites to which the cancer has spread. If cancer metastasized to only one site, treatment is usually a nephrectomy and surgical removal of the metastatic tumor. If the tumor has spread to more than one site, surgery to reduce the size of the tumor(s) is generally recommended, but it may not be the best choice for everyone. Targeted therapy and immunotherapy are options. If first-line therapy with targeted therapy or immunotherapy fails, second-line therapy may be an option. A clinical trial may be an option (see Clinical Trials). Radiation therapy may be used as palliative therapy.
Recurrent Disease after Surgery
RCC recurs (returns) in approximately 20 to 30 percent of people with Stage I, II or III tumors that have been surgically removed. When RCC recurs, it’s usually within the first three years after surgery, and the recurrence may be in the kidney or at a distant site in the body. If the cancer recurs in the kidney and can be removed, a partial or radical nephrectomy may be done, assuming enough time has passed after the first procedure. If the cancer comes back outside the kidney, the treatment options are the same as for cancer that is Stage IV at the time of diagnosis.
