• Stage I or stage II
Patients with stage I and II kidney cancer - renal cell carcinoma (RCC). most often have their cancers surgically removed by either radical or partial nephrectomy. Additional (adjuvant) chemotherapy, radiation therapy, or immunotherapy after surgery for stage I or stage II kidney cancer - renal cell carcinoma (RCC). is not recommended. Patients who are unable to tolerate kidney surgery because of other serious medical problems are often treated by experimental procedures such as cryoablation or arterial embolization. With surgical treatment, the 5-year survival for stage I patients is between 88% and 100% and the 5-year survival for stage II patients is between 63% and 67%.
• Stage III
Radical nephrectomy is the most common treatment for stage III kidney cancer - renal cell carcinoma (RCC). Sometimes, a patient will have an arterial embolization procedure in attempt to reduce the amount of bleeding during nephrectomy. If the cancer extends into nearby veins, the surgeon may need to cut open these veins and to completely remove the cancer. The 5-year survival for stage III patients varies widely and is between 40% and 80%, depending on the local extent of the cancer.
• Stage IV
Stage IV kidney cancer means that the cancer has grown outside of the kidney or it has spread to other parts of the body such as distant lymph nodes or other organs. Treatment of stage IV kidney cancer depends on how extensive the cancer is and on the person’s general health. In some cases, surgery may still be a part of 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 probably 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 (interleukin-2). More often targeted therapy is used first. It’s not clear if any one of the targeted therapies or any particular sequence is better than another, although temsirolimus appears to be most useful in people with kidney cancers that have a poorer prognosis (outlook).
For cancers that can’t be removed surgically (because of the extent of the tumor or a person’s health), first-line treatment is likely to 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 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 can help you maintain your quality of life. It’s 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.
• Recurrent cancer
Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Treatment of kidney cancer that comes back (recurs) after initial treatment depends on where it recurs and what treatments have been used, as well as a person’s health and wishes for further treatment.
For cancers that recur after initial surgery, further surgery might be an option. Otherwise, treatment with targeted therapies or immunotherapy will probably be recommended. Clinical trials of new treatments are an option as well.
For cancers that progress (continue to grow or spread) during treatment with 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 renal cell 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.