Stage I, II, or III

These cancers are usually removed surgically when possible. Radical nephrectomy is usually the operation of choice. If you have a smaller stage I tumor, have only one good kidney, have cancer in both kidneys, or have an inherited condition like von Hippel-Lindau (VHL) disease, a partial nephrectomy may be an option. For larger or more extensive tumors, radical nephrectomy is more likely than partial nephrectomy to be curative. Some patients may have an arterial embolization before surgery to reduce the amount of bleeding during nephrectomy. Lymph nodes around the kidneys may be removed as well. If the cancer has grown into nearby veins (as with some stage III cancers), the surgeon may cut open these veins, remove the cancer, and repair the vein.

Other than as part of a clinical trial, adjuvant (additional) treatments such as targeted therapy, chemotherapy, radiation therapy, or immunotherapy are usually not recommended after surgery, as the benefit of additional therapy has not been proven.

If you cannot have kidney surgery because of other serious medical problems, you may benefit from other local treatments such as cryotherapy, radiofrequency ablation, radiation therapy, or arterial embolization, although they are much less likely than surgery to cure the cancer.

Stage IV

Treatment of stage IV kidney cancer depends on how extensive the cancer is and on a person's general health. In some cases, surgery may still play a role in treatment.

In rare cases where the main tumor appears to be removable and the cancer has only spread to one other area (such as to one or a few spots in the lungs), surgery to remove both the kidney and the metastasis may be an option if a person is in good enough health. Otherwise, treatment with one of the targeted therapies would likely be the first option.

If the main tumor is removable but the cancer has spread extensively elsewhere, removing the kidney may still be helpful. This would likely be followed by systemic therapy, which might consist of one of the targeted therapies or cytokine therapy (IL-2 or interferon). It's not clear if any one of the targeted therapies is better than the others, although temsirolimus appears to be most useful in people with kidney cancers that have a poorer prognosis.

For cancers that can't be removed surgically (because of the extent of the tumor or a person's health), first-line treatment would likely be one of the targeted therapies or cytokine therapy.

Because advanced kidney cancer is very hard to cure, clinical trials of new combinations of targeted therapies, immunotherapy, or other new treatments are also options.

For some patients, palliative treatments such as embolization or radiation therapy may be the best option. A special form of radiation therapy called stereotactic radiosurgery (using a Gamma Knife) can be very effective in treating single brain metastases. Surgery or radiation therapy can also be used to help reduce pain or other symptoms of metastases in some other places, such as the bones.

Having your pain controlled appropriately can help you maintain your quality of life. It is important to realize that medicines to relieve pain do not interfere with your other treatments and that controlling pain will often help you be more active and continue your daily activities.

Cancer That Progresses or Recurs (Comes Back) After Treatment

Treatment of kidney cancer that comes back (recurs) after initial treatment depends on where it recurs, what treatments have been used, and on a person's health and wishes for further treatment.

For cancers that recur after initial surgery, further surgery might be an option in some cases. Otherwise, treatment with targeted therapies or immunotherapy will likely be recommended. Clinical trials of new treatments are an option as well.

For cancers that progress (continue to grow or spread) during treatment with a targeted therapy or cytokine therapy, another type of targeted therapy may be helpful, at least for a time. If these don't work chemotherapy may be tried, especially in people with non-clear cell types of kidney cancer. Clinical trials may be a good option in this situation for those who want to continue treatment.

Again, for some patients, palliative treatments such as embolization or radiation therapy may be the best option. Controlling symptoms such as pain is an important part of treatment at any stage of the disease.

Last Revised: 10/22/2007