Treatment of Stage IV Kidney (Renal Cell) Cancer

This content has been reviewed and approved by

Robert J. Motzer, MD
Attending Physician

Memorial Sloan-Kettering Cancer Center

In stage IV renal cell cancer, the original kidney tumor has spread to nearby structures outside the kidney to distant areas or to more than one lymph node. (Lymph nodes are little filters scattered throughout your body that help destroy bacteria and viruses.)

If you have stage IV renal cell cancer, your doctor may offer you targeted therapies, such as Sutent^® (sunitinib) or Nexavar^® (sorafenib); or biologic therapy, such as Proleukin^® (aldesleukin). Surgery may also be appropriate when it is possible to remove the cancer in the kidney and at one or a few sites of metastasis without serious side effects. Your doctor may also offer you the choice of participating in a clinical trial.

When surgery is appropriate, doctors use a procedure called cytoreduction (also known as cytoreductive nephrectomy) to treat stage IV renal cell cancer. Cytoreduction is the removal of as much of the original kidney tumor and nearby metastases as possible. The goal is to prevent local complications and improve symptoms. Most doctors agree that it's important to remove the original cancerous tumor if possible, though this has no direct effect on distant cancer spread.

Any remaining cancerous tissue is then targeted by nonsurgical treatment. This is necessary because tiny, microscopic areas of cancer that the doctor cannot see may remain after surgery and cause the cancer to return. Also, distant metastases (areas that cancer has spread that are distant from the kidney) may be present.

Doctors use targeted therapy, biologic therapy, chemotherapy, or combined agents to destroy cancer cells and decrease the risk that cancer will return or progress. In general, targeted or biologic therapy are more likely than chemotherapy to provide good results in the treatment of stage IV renal cell cancer. Targeted therapy is of increasing interest to physicians because it may provide new opportunities for helping patients with stage IV renal cell cancer that have not been provided by biologic therapy.

Research is in progress to refine existing treatments and develop new ones. For information on some of the techniques currently under investigation, see Strategies to Improve Treatment.