The tumor invades adjacent organs (T4), nearby lymph nodes (N4) or has distant metastases (M1).
Approximately 30 percent of cases are diagnosed in Stage IV, with 10 percent having a low-grade and more than 60 percent a high-grade tumor.
Standard Treatment The role for radical nephrectomy is debatable, since most patients die from metastatic disease. In the past it was thought that removing the primary cancerous kidney would cause the metastases to shrink. But spontaneous shrinkage of tumors has been documented in only 2 percent of cases at best, so the era of treatment of metastases by radical nephrectomy following embolization is over.
Nephrectomy is again being considered, however, to debulk (reduce) the tumor volume in order to make immunological treatment more effective for remaining disease. Nephrectomy for Stage IV cases should only be considered when part of an investigational study or for severe hemorrhage.
Five-Year Survival 5 percent
Investigational
• Participation in an experimental protocol , as outlined for Stage II, would be very appropriate.
