Advanced kidney cancer: what to ask when starting a new treatment

The kidneys are a pair of fist-sized organs located on either side of the spine, just below the rib cage. These organs are part of the urinary system and act as filters for the blood, removing waste and excess fluid that can be expelled from the body as urine.

Renal cell carcinoma (RCC) is the most common type of cancer that begins in the kidneys. RCC is considered advanced when the cancer cannot be completely removed with surgery or destroyed with another type of local therapy, such as radiation therapy. It includes some stage III cancers, non-metastatic stage IV cancers, and metastatic cancers (which are all stage IV).

Treatment for advanced RCC

While advanced RCC is not considered curable, there are treatments that can help reduce symptoms, improve quality of life, and help a person live longer.

Because advanced RCC has spread beyond the kidneys and cannot be completely removed by surgery, treatment typically involves systemic therapies—medications that travel through the bloodstream to reach cancer cells throughout the body. Systemic therapies include immunotherapy, targeted therapy, and chemotherapy. These drugs are often used in combination with one another. Using multiple immunotherapy drugs or immunotherapy plus targeted therapy has become a standard first-line treatment for advanced RCC.

Surgery to remove tumors and procedures to destroy specific tumors may also be used as a part of treatment for advanced RCC in some circumstances (though these treatments are more commonly used to treat early-stage RCC).

Treatment recommendations are based on multiple factors, including the type and characteristics of the cancer, where it has spread, your overall health, and how the cancer might respond to different therapies. Your preferences about treatment are also a factor that should be considered.

Questions to ask when discussing a new treatment

Treatment for advanced RCC is often a multistep process and you may find yourself starting or switching therapies during different points in treatment.

The following questions can be helpful when starting a new treatment or discussing your treatment options.

If you are discussing a medication:

• What is the name of the medication and the dosage?
• How does the medication work?
• How is the medication administered?
• How often will this medication be administered?
• How long will I be taking this medication?
• What is the goal of this therapy? How will we know it is working?
• What happens if this treatment stops working?
• What are the potential side effects? Is there a risk of serious side effects?
• How will I feel while taking this medication? What steps can we take to help manage side effects?
• Are there things I will need to avoid while taking this medication, such as certain foods or activities?
• Can this medication interact with other medications or supplements? Always tell your healthcare provider about all medications you are taking, including medications for other conditions, over-the-counter medications, and supplements.
• What will this therapy cost? Who can I talk to if I have concerns about the cost of treatment?

If you are discussing a medical procedure or surgery:

• What is the name of the procedure?
• What is removed during this procedure? Will I need reconstructive surgery?
• What is the goal of the procedure?
• What are the potential side effects or risks involved with this procedure?
• Do I need any tests or exams before this procedure?
• What healthcare provider will perform this procedure?
• Are there any alternatives to this approach to treatment?
• What will this procedure cost?
• What will the recovery process be like? How long will the recovery process take?

Remember, if you have questions about a diagnosis or treatment, need an explanation, or have concerns, your healthcare provider is your best source of information.