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Kidney Cancer our Pleaseonline surveycomplete at NCCN.org/patients/survey NCCN GUIDELINES FOR PATIENTS® 2020 Kidney Cancer Presented with support from: Available online at NCCN.org/patients Ü Kidney Cancer It's easy to get lost in the cancer world Let Ü NCCN Guidelines for Patients® be your guide 9 Step-by-step guides to the cancer care options likely to have the best results 9 Based on treatment guidelines used by health care providers worldwide 9 Designed to help you discuss cancer treatment with your doctors NCCN Guidelines for Patients®: Kidney Cancer, 2020 1 About NCCN Guidelines for Patients® are developed by the National Comprehensive Cancer Network® (NCCN®) NCCN Clinical Practice ® Ü Ü NCCN Guidelines NCCN Guidelines in Oncology ® ® for Patients (NCCN Guidelines ) 9 An alliance of 28 leading 9 Developed by doctors from 9 Present information from the cancer centers across the NCCN cancer centers using NCCN Guidelines in an easy- United States devoted to the latest research and years to-learn format patient care, research, and of experience education 9 For people with cancer and 9 For providers of cancer care those who support them all over the world Cancer centers 9 Explain the cancer care that are part of NCCN: 9 Expert recommendations for options likely to have the NCCN.org/cancercenters cancer screening, diagnosis, best results and treatment NCCN Quick Guidetm Sheets Free online at 9 Key points from the NCCN NCCN.org/guidelines Guidelines for Patients Free online at NCCN.org/patientguidelines and supported by funding from NCCN Foundation® These guidelines are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Kidney Cancer (Version 1.2020, June 7, 2020). © 2019 National Comprehensive Cancer Network, Inc. All rights reserved. NCCN Foundation® seeks to support the millions of patients and their families NCCN Guidelines for Patients® and illustrations herein may not be reproduced affected by a cancer diagnosis by funding and distributing NCCN Guidelines for in any form for any purpose without the express written permission of NCCN. No Patients®. NCCN Foundation is also committed to advancing cancer treatment one, including doctors or patients, may use the NCCN Guidelines for Patients for by funding the nation’s promising doctors at the center of innovation in cancer any commercial purpose and may not claim, represent, or imply that the NCCN research. For more details and the full library of patient and caregiver resources, Guidelines for Patients that have been modified in any manner are derived from, visit NCCN.org/patients. We rely solely on donations to fund the NCCN Guidelines based on, related to, or arise out of the NCCN Guidelines for Patients. The NCCN for Patients. To donate, visit NCCNFoundation.org/Donate. Guidelines are a work in progress that may be redefined as often as new significant data become available. NCCN makes no warranties of any kind whatsoever National Comprehensive Cancer Network® (NCCN®) and NCCN Foundation® regarding its content, use, or application and disclaims any responsibility for its 3025 Chemical Road, Suite 100 | Plymouth Meeting, PA 19462 | 215.690.0300 application or use in any way. NCCN Guidelines for Patients®: Kidney Cancer, 2020 2 Supporters Endorsed and sponsored in part by The Kidney Cancer Association (KCA) is a 501c(3) non-profit organization focused on kidney cancer patients and their families. The KCA provides medical research for the cure and treatment of the disease, patient advocacy, physician education, and patient and caretaker education and support. To learn more, visit www.kidneycancer.org. Also endorsed by Urology Care Foundation The Urology Care Foundation is the world’s leading nonprofit urological health foundation – and the official foundation of the American Urological Association. As an organization who strongly believes in providing patients, caregivers and those impacted by kidney cancer educational tools and resources to make informed decisions about their health and treatment, we are pleased to endorse the NCCN Guidelines for Patients: Kidney Cancer. www.urologyhealth.org/ NCCN Guidelines for Patients®: Kidney Cancer, 2020 3 NCCN Guidelines for Patients®: Kidney Cancer, 2020 4 Kidney Cancer Contents 6 Kidney cancer basics 13 Testing for kidney cancer 21 Kidney cancer staging 27 Kidney cancer treatment 43 Treatment guide: Stage I 48 Treatment guide: Stage II 51 Treatment guide: Stage III 55 Treatment guide: Stage IV 63 Making treatment decisions 72 Words to know 77 NCCN Contributors 78 NCCN Cancer Centers 80 Index NCCN Guidelines for Patients®: Kidney Cancer, 2020 5 1 Kidney cancer basics 7 The kidneys 9 Types of kidney cancer 11 How kidney cancer spreads 12 Review NCCN Guidelines for Patients®: Kidney Cancer, 2020 6 1 Kidney cancer basics The kidneys Learning that you have cancer can The kidneys are a pair of organs found behind the feel overwhelming. Understanding the other organs in your abdomen. Each kidney is about basics about kidney cancer will help you the size of an adult’s fist. The kidney is covered by prepare and plan for treatment. a thin layer of tissue, like the skin of an apple. This layer of tissue is called the renal capsule. Renal refers to the kidney. An adrenal gland sits on top of each kidney. The The kidneys kidney and adrenal gland are surrounded by a layer of fat. Covering the fat is an outer layer of fibrous tissue called Gerota’s fascia. Gerota’s fascia is The kidneys are part of the urinary system, shown in important. When kidney cancer grows into and Figure 1. The urinary system is a group of organs beyond Gerota’s fascia it becomes it is a sign of that remove waste from the body in the form of urine advanced kidney cancer. See Figure 2. or pee. This system includes the kidneys, ureters, bladder, and urethra. Figure 1 The kidneys and urinary system The kidneys are a pair of organs in the abdomen. The kidneys are the main organs of the urinary system. They filter waste out of blood and make urine. The ureters, bladder, and urethra hold and transport urine before it is released from the body. NCCN Guidelines for Patients®: Kidney Cancer, 2020 7 1 Kidney cancer basics The kidneys How the kidneys filter and clean blood The clean, filtered blood flows out of the kidney The kidneys perform many jobs to keep your body through the renal vein. The renal vein merges with healthy. They make hormones that help control blood a larger vein called the vena cava. The vena cava pressure. They also make hormones that tell the takes clean blood back up to the heart. body to make more red blood cells. The main job of the kidneys is to filter blood to remove waste and Urine flows out of the renal tubules and collects in a extra water from the body. By filtering the blood, the hollow space in the middle of the kidney called the kidneys also control and balance the levels of fluids renal pelvis. Urine leaves the renal pelvis through a and chemicals in your body. long tube called the ureter. The ureter carries urine to the bladder. The bladder holds urine until it is The renal artery carries blood with waste into the released from the body, when you urinate or pee. A kidney. See Figure 3. Blood then flows through shorter tube, called the urethra, takes urine from the tiny filtering tubes in the kidney called renal tubules. bladder to outside the body. Blood is cleaned as it flows through the renal tubules. The renal tubules take waste and other substances Most people have two kidneys. But, each kidney out of the blood. These substances are made into works on its own and does not need the other to urine. function. This means that the body can often work well with less than one complete kidney. Many people live full, healthy lives with only one kidney. Figure 2 The kidney and adrenal gland An adrenal gland sits on top of each kidney. The kidney and adrenal gland are surrounded by a layer of fatty tissue. Surrounding the fat is a layer of fibrous tissue called Gerota’s fascia. Derivative work of Kidney and Adrenal Gland by Alan Hoofring from NCI Visuals Online. Available at: https://visualsonline.cancer.gov/details.cfm?imageid=4355 NCCN Guidelines for Patients®: Kidney Cancer, 2020 8 1 Kidney cancer basics Types of kidney cancer Types of kidney cancer There are 3 rare cancers that start in the urinary system, but do not act the same and are not treated Cancer is a disease that starts in the cells of your the same as kidney cancer. body. Most cancer is named after the cell from which it formed. Kidney cancer starts in the tissues of the Transitional cell carcinoma (TCC) - TCC starts kidneys. in the cells that line the renal pelvis, where the ureters meet the kidneys. This is also called Almost all kidney cancers are carcinomas. urothelial carcinomas or transitional cell cancer. Carcinomas are cancers that start in cells that Wilms tumor (nephroblastoma) - Wilms tumor is line the inner or outer surfaces of the body. In the very rare and usually occurs in young children. kidneys, carcinomas most often start in the cells Cancer cells are found in the kidney. that line the renal tubules. This is called renal cell carcinoma (RCC). About 9 out of 10 kidney cancers Renal sarcoma - Renal sarcoma starts in are RCCs. See Figure 4. Because it is the most the blood vessels or connective tissue of the common type, RCC is often simply referred to as kidney. (For information about sarcomas, read kidney cancer. RCC is the focus of this guideline. NCCN Guidelines for Patients®: Soft Tissue Sarcoma, available at www.nccn.org/patients.) Figure 3 The kidneys filter blood to remove waste Blood travels throughout the body in a network of tubes called blood vessels.
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