Renal cancer

Question 1

Stage T1a

Answer 1

The tumor is found only in the kidney and is 4 cm or smaller at its largest area

Question 2

Stage T1b

Answer 2

The tumor is found only in the kidney and is between 4 cm and 7 cm at its largest area.

Question 3

T2a

Answer 3

The tumor is only in the kidney and is more than 7 cm but not more than 10 cm at its largest area.

Question 4

T2b

Answer 4

The tumor is only in the kidney and is greater than 10 cm

Question 5

T3a

Answer 5

The tumor has spread to the large vein leading out of the kidney, called the renal vein, or the branches of the renal vein; the fat surrounding and/or inside the kidney; or the pelvis and calyces of the kidney, which collect urine before sending it to the bladder. The tumor has not grown beyond Gerota’s fascia.

Question 6

T3b

Answer 6

The tumor has grown into the inferior vena cava, below the diaphragm.

Question 7

T3c

Answer 7

The tumor has spread to the vena cava above the diaphragm and into the right atrium of the heart or to the walls of the vena cava.

Question 8

T4

Answer 8

The tumor has spread to areas beyond Gerota’s fascia and extends into the adrenal gland on the same side of the body as the tumor.

Question 9

Stage 1 T1a primary treatment

Answer 9

partial nephrectomy or ablative technique or active surveillance or radical nephrectomy

Question 10

Stage 1 T1b primary treatment

Answer 10

partial nephrectomy or active surveillance or radical nephrectomy

Question 11

Stage 2 (T2)

Answer 11

partial nephrectomy or radical nephrectomy (plus clinical trial or surveillance adjuvant therapy)

Question 12

Stage 3 (T1/T2N1M0 or T3NxM0)

Answer 12

radical nephrectomy or partial if clinically indicated

If clear cell–>clinical trial (preferred) or surveillance or sunitinib (category 3)

Question 13

Stage 4 (T4NxM0 or TxNxM1) Potentially Resectable treatment

Answer 13

Consider tissue sampling–> Cytoreductive nephrectomy in select patients or systemic therapy (preferred in clear cell histology with poor risk features)

Question 14

Stage 4 (T4NxM0 or TxNxM1) Unresectable treatment

Answer 14

Tissue sampling then treatment based on clear cell versus non clear cell

Question 15

Stage 4 with clear cell treatment

Answer 15

clinical trial
or
favorable: Axitinib and pembrolizumab vs. pazopanib vs. sunitinib
poor/intermediate: Ipilimumab and nivolumab vs. Axitinib and pembrolizumab vs. Cabozantinib
or