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Back Mike Peterson My father, Mike, was an avid naturalist and outdoorsman who could pretty much run circles uphill around people who were half his age. It was hard to keep up with him! He had always been a muscular, yet petite man. He was a quiet, reserved man, who, despite that, loved to joke and show others a slower pace of life. During the last half of 2024, though, he began to notice he didn't have the same strength and energy he had always had. His appetite, which had always been vigorous, was gone now, too. He thought it was all a part of aging, since he had just retired. The fatigue persisted. He would still climb the steep hills around his house in order to chop firewood and manually haul huge logs down to his house via wheelbarrow, but, now it took extreme effort for him to do so. But still, that man was tough as a pine knot to do the things he did. I, along with other concerned loved ones, thought maybe him slowing down and being more reclusive was depression. By March of 2025, he was sleeping excessively, and he had night sweats. Still, he refused to go to the doctor and he still managed to go up into the woods. Back in his 20s and 30s, he had had reoccurring kidney stones that had resulted in multiple surgeries. It made him fear going back to doctors. "They're just looking for something to be wrong with me." When we went out for lunch for Mother's Day, it was clear to me how much weight he had lost. He didn't eat much at all, and he was irritable, which wasn't like him at all. It was obvious to me something was wrong, because he wasn't acting like his normal self. His voice sounded strained, as well. His wife begged him to go to the doctor, and I did too. This battle with trying to convince my dad went back and forth with him until he finally agreed at the end of May to go to the local Emergency Department to get tests. It started out that they found a tumor on his kidney and his oxygen was low. He was immediately told to go to another local hospital that could perform better imaging. He would be admitted to that hospital. Someone asked him how long he had felt sick, and he told them "too long". More findings. He had tumors in his kidneys, liver and lungs. His diagnosis was stage 4 renal cell carcinoma. Other than the loss of appetite and fatigue, he said he hadn't had kidney pain or any other symptoms. He said he'd fight it like a tiger, no matter what the outcome. He and I discussed the facts of his diagnosis, and he wanted me to know that his prognosis wasn't good. He had worked in a long-term health facility for 32 years and he had seen a lot during that time. He and I knew treatments could bring comfort, and we wanted quality of life. I wanted my daddy cured, but, I knew it wouldn't be. He was sent home with oxygen support. His first immunotherapy was set to start on July 1st. On June 30th, he ended up in the Emergency Department again due to confusion, low oxygen, and blood clots that were discovered in his leg and lungs. He told me that morning he was ready to go home. His last words to me were "I love you." He passed away quietly the next morning, on July 1st, the same day he would have begun his immunotherapy. In his own way, on his own terms, he had received his ultimate healing from kidney cancer. I love and miss you, Daddy, every single day.

Back Sid Sadler Being diagnosed with kidney cancer at 32 years of age wasn't in my "plan," if we want to call it a plan. I'm 34 now, and approaching another round of scans to ensure the cancer removed from my body is gone. December of 2023, I had an episode of hematuria in my urine, and that led to a CT which revealed a 10.5 cm tumor on my left kidney. A slew of appointments made with Vanderbilt led to a plan of a radical nephrectomy removing my tumor and left kidney. February of 2024 the surgery took place. Surprisingly, I recovered well. I had my surgery on a Monday, and I was home that Wednesday afternoon. Eagerly awaiting my pathology results, while also browsing the internet for others in my situation. I didn't find many, but I found a few, and I leaned on those few very hard. With no other evidence of disease, I hoped for a diagnosis of stage two or three, knowing other factors such as grade and type played a big factor in my outlook. The results come back. Stage 2b, grade two Clear Cell Renal Carcinoma. After meeting with my team, a scan schedule was put into place. Hesitant and nervous at first, I learn the rhythm we all learn after cancer enters our lives. Soon thereafter, my wife and I find out she is expecting a baby, and our world goes from one end of the spectrum to another end of emotions. We welcome a beautiful healthy baby girl into the world just short of one year after my surgery. Life is crazy, isn't it? I started as a scared patient, and I still am. However, I'm also equipped with knowledge now, and most importantly perspective. I dove into advocacy, joining the patient family advisory councils at Vanderbilt Ingram Cancer Center, and The Kidney Cancer Association. I was recently invited to join the Board of Directors for The Judy Nicholson Kidney Cancer Foundation. If I could say one thing to you, it's that cancer isn't a period for a lot of us. It's a comma. Once a plan is set in place, things will get better. We have come a long way in treatment for both localized and stage four kidney cancer. I'm confident in my team and the other countless doctors researching this disease. Onward.

Visualize your kidney cancer journey with my comprehensive diagram, designed to simplify complex information. Common Patient Journey - Kidney Cancer Testing Diagnosis Treatment Surveillance Emotional Support Signs & Symptoms Imaging CT Scan MRI Bone Scan Biopsy Types and Grades Renal Cell Papillary Chromophobe Surveillance Imaging Ablation Surgery Lab Tests Physician Visit Immunotherapy Collecting Duct Renal Medullary Treatment by Stage Psychotherapy 1-on-1 Support Online Community Reduce Stress Stages Forward Back ? Narrative

Read press releases from KidneyCouch. PRESS RELEASES 1 / Partnership Announcement with Smart Patients February 13, 2026 FOR IMMEDIATE RELEASE: KidneyCouch Supports Patients and their Families with an Online Kidney Cancer Community KidneyCouch partners with Smart Patients to create a new online kidney cancer community that will make it easier for patients and families to support and learn from one another. ROCHESTER, MN, February 13, 2026: Today, KidneyCouch is proud to announce a new partnership with Smart Patients, an online peer-to-peer support forum for patients and their families, which allows KidneyCouch to extend its ability to help those impacted by kidney cancer by adding virtual social and emotional support to their outreach programs. Patients and families affected by kidney cancer can join the Smart Patients kidney cancer or chronic kidney disease community for free to share, interact, and learn from each other in a safe, supportive environment. Patients are invited to join the kidney cancer community through the following link: KidneyCouch Smart Patients Community. Individuals can join the community by securely sharing their email addresses and setting up a free personal account. Once the account is confirmed participants will have access to information, and resources, and be able to participate in community conversations on topics of interest. About KidneyCouch KidneyCouch is dedicated to providing a supportive and informative space for kidney cancer patients and those who are also dealing with chronic kidney disease (CKD). It provides resources, stories, and articles to its community members. About Smart Patients: Smart Patients is an online community where patients and caregivers affected by serious illnesses learn from each other. Members share personal experiences, ask and answer questions, and gain knowledge in an ad-free, private space that helps them make better-informed decisions about their care. The platform hosts more than 100 disease-specific communities and is free to join. Learn more at KidneyCouch Smart Patients Community. Contact: Kristi Lynden kristi@smartpatients.com Smart Patient Social Media Handles: Facebook (@smartpatientscommunity) Instagram and Threads (@smart_patients_community) LinkedIn (@Smart Patients) Bluesky (@smartpatients.bsky.social) 2 / Affiliate Partnership Announcement with the Kidney Cancer Association October 20, 2025 KCA Welcomes New Affiliate Partner KidneyCouch Kidney Cancer Association The Kidney Cancer Association (KCA) welcomes KidneyCouch as a new Affiliate Partner. KidneyCouch is committed to offering support and information to individuals battling kidney cancer and/or chronic kidney disease (CKD) with a goal to create a community that fosters connection, understanding, and empowerment for patients and their loved ones. Founder Jeff Kallis, 64, was diagnosed with stage 3 clear cell renal cell carcinoma (RCC) in 2023 and has since written a book about his journey, has been featured in multiple news stories, and created KidneyCouch to increase awareness, education, and support for patients and family members dealing with kidney cancer and chronic kidney disease. His personal mission has always been to connect with and support fellow patients so that no one has to walk this journey alone. For more information about Kallis’s full story, visit KidneyCouch – About. Jeff Kallis’ kidney cancer prompted questions. He wanted to help others find answers. “KidneyCouch is proud to create this affiliation with the Kidney Cancer Association,” Kallis said. “There is strength in unity and there is no better partner than the KCA in creating awareness, education, and finding a cure for kidney cancer.” “It’s gratifying to see how Jeff has used his personal experience to create a welcoming space for meaningful connection,” said Gretchen E. Vaughan, KCA’s President and CEO. “With our shared values, we are looking forward to working together!” The KCA’s Affiliate Partners help expand the support available for people impacted by kidney cancer and allows for strategic collaborations that will advance research, advocacy, and education. KidneyCouch joins seven existing KCA Affiliate Partner organizations: the Chris “CJ” Johnson Foundation, the Chromophobe and Oncocytic Tumor Alliance, HLRCC Foundation, Elevate Childhood Research and Advocacy, Joey’s Wings Foundation, the Judy Nicholson Kidney Cancer Foundation, and the Wilms Cancer Foundation. Media Contact: Radha Chitale Senior Director of Communications 847.332.1051 ext. 113 | rchitale@www.kidneycancer.org 3 / Partnership Announcement with Imerman Angels August 15, 2025 KidneyCouch is pleased to announce that it has formed a partnership with Imerman Angels. Imerman Angels matches a cancer patient with another cancer patient with similar stories and experiences. In addition to the support I received from my wife Cindy, our sons, family, and friends, it would have been very helpful to have a personal connection with someone who had the same diagnosis and story as mine. There are people out there who want to be available to help others navigate their cancer journey – relating to you on a level that others cannot. Now, I want to “give back” to other people diagnosed with kidney cancer and need some emotional / social support as they ride this roller coaster. In July, I became a certified Imerman Angels Mentor Angel to do just that. No one needs to navigate the unknowns alone. Imerman Angles intentionally matches cancer patients according to age, gender, type of cancer, and experience; so, you know you are talking to someone who truly understands what you’re going through, in a supportive and caring connection. Imerman Angels provides this connection free of charge to anyone seeking support, connection and community. If you know of anyone who is dealing with cancer and would like or benefit from a one-on-one connection, please reach out to Imerman Angels at https://imermanangels.org/. If you are cancer survivor and would like to become a Mentor Angel, reach out to Imerman Angels at https://imermanangels.org/give-support/. To learn more about Imerman Angels, visit these links: KidneyCouch / Imerman Angels Partnership: https://www.kidneycouch.com/imermanangels Imerman Angels Resource / Partner Page: https://imermanangels.org/resources/ Imerman Angels – Home Page https://imermanangels.org/

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Stay informed with our periodic newsletter, featuring the latest updates, tips, and resources for kidney cancer and CKD. Periodic newsletters from KidneyCouch August 2025 Features the new partnership with Imerman Angels. October 2025 Features the new Affiliate Partnership with Kidney Cancer Association February 2026 Features the new partnership with Smart Patients. Join our mailing list Email* Subscribe I want to subscribe to your mailing list.

Following the proper diet is critical for your kidney health. Learn valuable tips from trusted experts. Kidney Friendly Diets Illustration by wellness.rice.edu Kidney Diet Links Eating healthy benefits you in many ways, one of which is your kidneys. These are just a few eating tips to check out. Mediterranean Diet Best Foods for Kidney Diet Eating Right for Chronic Kidney Disease Kidney Friendly Diet Kidney Diet Recipes Kidney Health Diet - Basics Eat Well Diet Example - Jeff Kallis's Diet Healthy habits include not sitting on the couch all day. Unless you're sitting around the couch with us!

Engage with Kidney Couch Interactive for personalized tools and resources to support your kidney cancer journey. KidneyCouch Interactive © Copyright Are you or a loved one currently dealing with kidney disease and in need of support and connection to interactive tools and engagement? Forums for discussion can facilitate deeper engagement among individuals dealing with kidney cancer and chronic kidney disease, fostering a sense of belonging within the community of patients dealing with similar issues. Kidney Cancer Support Groups KidneyCouch Community - Smart Patients Kidney Cancer Information and Support Community - Kidney Cancer Association Patient Perspectives - Virtual Support Group - Kidney Cancer Association Kidney Cancer Unfiltered - Podcasts - Kidney Cancer Association Kidney Cancer Support Group - Mayo Clinic Stages1-2-3 Kidney Cancer Support Community - KCCure Chronic Kidney Disease (CKD) Support Group Go To KidneyCouch Community One-on-One Connection One-on-One Cancer Support Community Resource Partners Imerman Angels provides free, personalized one-on-one cancer support for cancer fighters, survivors, previvors and caregivers. The purpose of the matches made by Imerman Angels is to provide one-on-one cancer support from someone who has been there. To reach out to Imerman Angels to find a mentor for one-on-one support, go to https://imermanangels.org/find-mentor-angel/ Imerman Angels – Certification 🎉 Proud to be part of Imerman Angels! 🌟 I completed the Mentor training at Imerman Angels in June 2025 and am officially a Mentor Angel. Imerman Angels provides free one-on-one support to cancer fighters, survivors, previvors, and caregivers to ensure no one faces cancer alone. Sign up to be a Mentor or Mentee and learn more at @imermanangels or visit their website imermanangels.org Patient-Focused Tools Recent Trends in SEER Age-Adjusted Incidence Rates, 2000-2022 By Sex, Delay-adjusted SEER Incidence Rate, All Races / Ethnicities, All Ages, All Stages Quick Quiz: Kidney Cancer Take the Quiz Cancer Survivors Network Kidney Cancer cBioPortal - Cancer Genomic Data Kidney Cancer

Find emotional support and resources to help you and your loved ones cope with kidney cancer and CKD challenges. Emotional Rollercoaster Ride Dealing with kidney cancer and chronic kidney disease can be like a roller coaster ride that you want to get off. Here are some tips on how to deal with the emotional side of kidney disease. Emotions and Cancer Feelings Scanxiety Kidney Cancer Stories Navigating Cancer Tips Coping and Support Cancer Patient Advocate Examining the Relationship Patient Navigator - KCA Coping Effectively - CKD Psychosocial Effects Managing Emotions - Part I Managing Emotions - Part II

Review the terms and conditions for using KidneyCouch.com. Terms and Conditions KidneyCouch.com Last updated: June 3, 2025 Read and agree to these terms and conditions before using this Site. Table of Contents Interpretation and Definitions Interpretation Definitions Acknowledgment WE DO NOT PRACTICE MEDICINE User Accounts Creating an Account, Passwords, Security Your account on Our Service. 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Discover the role of surveillance in kidney cancer care, including monitoring strategies and what they mean for your health. Surveillance Clear cell, renal cell carcinoma (ccRCC) patient's that have a partial or radical nephrectomy are usually followed up under a surveillance program based on their individual case. General guidelines, such as those outlined by Dr. Brad Leibovich, Mayo Clinic, serve as recommendations for physicians to follow patients who have had a nephrectomy, monitoring the patient for any recurrence of renal cancer. Dr. Leibovich and his team developed the Progression-Free Survival Score to classify patient's as low, medium, and high risk for recurrence. Active Surveillance Follow Up for Kidney Cancer Predicting Outcomes in RCC Prognostic Models Patient Classification* The Leibovich Model recommends imaging / follow up for all patient classifications at 3 months post-surgery to check for recurrence as well as establish a new baseline for the patient for comparison against future imaging / testing. The higher the risk a patient is for recurrence, the more frequent are the intervals for ongoing testing. Stage I and II (Low Risk) 3 months post op CT or MRI with contrast of abdomen Chest x-ray Basic Metabolic Panel (BMP) then, Annually for 5 years after surgery (same testing as above) then, > 5 years Renal ultrasound Chest x-ray at clinical discretion Stage III (Intermediate Risk) 3 months post op CT or MRI with contrast of abdomen/pelvis Chest x-ray or CT Basic Metabolic Panel (BMP) then, 6 month intervals for 3 years (same testing as above) then, >3 years - Annually (same testing as above) then, > 5 years - Patient Specific Based on individual patient's case / history Stage IV (High Risk) 3 months post op CT or MRI with contrast of abdomen/pelvis Chest x-ray or CT Basic Metabolic Panel (BMP) then, 4 month intervals for 2 years (same testing as above) then, >2 years at 6 month intervals (years 3 to 5 after surgery) (same testing as above) then, > 5 years - Annually (same testing as above) *Based on published Mayo Clinic risk score (Leibovich BC, Cancer 2003;97:1663-1671) National Comprehensive Cancer Network Kidney Cancer Guidelines The National Comprehensive Cancer Network (NCCN) is a not-for-profit alliance of 33 leading cancer centers devoted to patient care, research, and education. The NCCN develops resources that present valuable information to stakeholders in health care. Part of their mission is creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. One of the guidelines is the recommended treatment for patients with kidney cancer. The most recent Kidney Cancer Treatment Guidelines (March 2025) can be viewed on the NCCN website in pdf format. These guidelines are detailed and extensive. Well worth your time and attention if you want to understand the details of the management and treatment guidelines for kidney cancer at all stages. An important note is that the guidelines are just that - guidelines. No single follow-up plan is appropriate (fits) all patients. Management should be individualized based on each patient's unique medical condition and other contributing factors.

A close up look at Jeff Kallis's journey with kidney cancer - diagnosis, a photo of the right kidney and what stage 3 renal cell carcinoma looks like. Kidney Cancer Example ccRCC Stage T3a, Grade 3 These images are from my personal journey with Clear Cell Renal Cell Carcinoma. I was diagnosed in January 2023 and had a radical nephrectomy in February 2023. jeff kallis CT Scan Images The CT scan on January 25, 2023 confirmed that I had a kidney stone) and pinpointed where the stone was located. I did have a 6 mm kidney stone from my left kidney, lodged in the ureter at the entrance of the bladder and refusing to move further. In addition, something more sinister was identified. A 5 cm mass in my other (right) kidney. Thank God for that kidney stone. I had no symptoms from the kidney mass itself, in the right kidney. CT scans and MRI's do a lot of slicing and dicing of body parts, and keeps them together in the end. Kidney Stone Kidney Tumor Pathology - Kidney This is my right kidney that was removed during my radical nephrectomy. The highlighted area is the kidney mass. The pathologist at Mayo Clinic, Dr. John Cheville, diagnosed the mass as Stage T3a, Grade 3, with renal vein invasion. The mass was a higher stage and grade and was more invasive than what could be seen with imaging alone. The time from when I was first tested for symptoms (January 20, 2023) until the tumor was removed from my kidney (February 15, 2023) was 27 days. That's one of many benefits from being seen at an integrated medical practice (Mayo Clinic Rochester) that specializes in kidney cancer. Profoundly grateful for the care and compassion I have received.

Partners and Affiliates of KidneyCouch.com. Affiliates and Partners KidneyCouch is proud to partner with organizations who's mission is to bring awareness, education, support, and resources to patients, friends and family members, and caregivers that experience kidney cancer journeys. Everyone has a story to tell. A unique, personal experience that we want to bring an additional voice to. The affiliations that we have forged share the mission of KidneyCouch to bring support and healing - medically and emotionally - through education and awareness for patients experiencing kidney cancer personally or within their circle of friends and family. We are pleased that the following organizations have joined us around the Couch to advance this mission. Kidney Cancer Association The KCA promotes scientific advances through two annual research symposiums and a robust grant program, participates in legislative advocacy, and seeks to be a source of education and resources for patients, caregivers, and anyone impacted by kidney cancer. KCA's vision is to be the universal leader in finding the cure for kidney cancer. Their mission is to be a global community dedicated to serving and empowering patients and caregivers, and leading change through advocacy, research, and education. Imerman Angels Imerman Angel's mission is to provide comfort and understanding for all cancer fighters, survivors, previvors and caregivers through a personalized, one-on-one connection with someone who has been there. Imerman Angels envisions a world where cancer is not a solitary experience. Smart Patients Smart Patients is an online community for patients and families affected by a variety of illnesses. Here you can learn at your own level about scientific developments related to your condition, share your questions and concerns with other members, and use what you learn in the context of your own life. We believe patients are the most underutilized resource in healthcare. We’ve watched patients become experts in their conditions — and we see that their knowledge improves the care they receive. With the right tools, you and other patients can do the same. Future Partners KidneyCouch is reaching out to other like-minded organizations to form affiliations with. Reach out if interested!

Explore kidney cancer treatment options, from surgery to targeted therapies, and make informed decisions about your care. Kidney Cancer Treatment Options Overview Kidney Cancer Treatments Diagnosis and Treatment Treatment Options - KCA Ablation Treatment Options - Small Tumor Roadmap - T1 Masses - MUSIC Surgery Nephrectomy - EAU Robot-Assisted Partial - EAU Surveillance Immunotherapy NCCN Evidence Blocks (pdf) Advances in Treatment NCCN Treatment Details Stage IV Treatment In stage IV kidney cancer, the main tumor has grown outside the kidney, or the cancer has spread to other parts of the body such as distant lymph nodes or other organs. Treatment of stage IV kidney cancer depends mainly on how extensive the cancer is and on a person’s general health. Experts agree that targeted therapy is the main treatment for stage IV kidney cancer. Targeted therapy uses drugs to target specific molecules on cancer cells or inside them. In some cases, surgery may still be a part of treatment. Surveillance Stage IV - (High Risk)* 3 months post op CT or MRI with contrast of abdomen/pelvis Chest x-ray or CT Basic Metabolic Panel (BMP) then, 4 month intervals for 2 years (same testing as above) then, >2 years at 6 month intervals (years 3 to 5 after surgery) (same testing as above) then, > 5 years - Annually (same testing as above) Treatment National Cancer Institute Canadian Cancer Society Healthline City of Hope Learn from the best: MD Anderson Memorial Sloan Kettering Dana-Farber *The Leibovich Model recommends imaging / close follow up for patients classified as Stage IV post-surgery. Based on published Mayo Clinic risk score (Leibovich BC, Cancer 2003;97:1663-1671) National Comprehensive Cancer Network Kidney Cancer Guidelines The most recent Kidney Cancer Treatment Guidelines (January 2026) can be viewed on the NCCN website in pdf format. These guidelines are detailed and extensive. Well worth your time and attention if you want to understand the details of the management and treatment guidelines for kidney cancer at all stages. An important note is that the guidelines are just that - guidelines. No single follow-up plan is appropriate (fits) all patients. Management should be individualized based on each patient's unique medical condition and other contributing factors.

Navigate your kidney cancer journey with stage-specific guidance and resources tailored to your needs. Top of Page Stage 4 Recurrent Stage 1 & 2 Stage 3 Common Journeys for Patients with ccRCC According to the Cancer Research Institute, 90 percent of kidney cancers are renal cell carcinoma (RCC). Of these, 70 percent have the subtype of "clear cell" renal cell carcinoma (ccRCC). Staging is a way to describe the cancer in terms of location and how far it has spread. It helps physicians determine the best course of treatment for the patient. The typical journey for each of the 4 stages ( I - IV ) is outlined below. 1 2 3 4 Information from the American Cancer Society, 2024, edited. Stage I and II cancers are confined to the kidney. Stage I is the least aggressive stage and has the highest five-year survival rate. Stage II is more serious than Stage I but still confined to the kidney. Active surveillance Some small (Stage I) cancers might not need to be treated right away. Small tumors often grow slowly, and some might never cause serious problems. Active surveillance might be an option for some people with small kidney tumors. The tumor is monitored closely with regular imaging tests (CT scans or MRI) and other tests. Further treatment may be necessary if the tumor grows or starts to show other concerning signs. Surgery If treatment is needed, the kidney cancer is usually removed with surgery when possible. Partial nephrectomy (removing the part of the kidney containing the cancer) is often the treatment of choice for smaller tumors. This is especially true for people who have reduced kidney function (or who might have it in the future). Radical nephrectomy (removing the entire kidney) is often favored if the tumor is larger, if it’s in the central part of the kidney, or if there’s more than one tumor in the kidney. Some lymph nodes near the kidney are often removed as well. More lymph nodes might need to be removed if any of them look enlarged on imaging tests, or if there’s a higher risk that the cancer might spread to the nodes. Most often, no further treatment is needed after surgery. If, after surgery, the cancer cells are found to have troubling features when evaluated in the lab (such as being very high grade), one option might be to get adjuvant (additional) treatment to help lower the risk of the cancer coming back. Other treatment options For people who aren’t healthy enough to have surgery or who don't want surgery, other local treatments such as cryotherapy or radiofrequency ablation (RFA) can sometimes be used to destroy (ablate) the kidney tumor. Radiation therapy (particularly stereotactic body radiation therapy, or SBRT) may be another option. Although these types of treatments can have outcomes similar to surgery as far as the chances of the cancer spreading to other parts of the body, some studies show the cancer might be more likely to come back in the same area. 1 and 2 Stage 1 & 2 Stage 3 3 Stage III kidney cancers have grown into nearby large veins or tissues around the kidney, and/or they have spread to nearby lymph nodes. Surgery Surgery is typically the treatment for Stage III. Most often, this is a radical nephrectomy, in which the entire kidney is removed. A partial nephrectomy (removing the part of the kidney containing the tumor) might also be an option if it’s possible, especially in people with reduced kidney function or who have tumors in both kidneys. Some lymph nodes near the kidney are often removed as well. More lymph nodes might need to be removed if any of them look enlarged on imaging tests , or if there’s a higher risk that the cancer might spread to the nodes. If the cancer has grown into the inferior vena cava (the large vein that brings blood from the lower part of the body back up to the heart), your surgeon may need to cut open this vein to remove all of the cancer. For clear cell RCC, an option after surgery is to get adjuvant (additional) treatment to help lower the risk of the cancer coming back (recurrence). Other treatment options For people who can’t have surgery for some reason, radiation therapy or ano ther type of local treatment might be options. Some stage III cancers can’t be removed completely by surgery or destroyed with other treatments. These cancers might get the same treatment as stage IV cancers, with t argeted therapy drugs, immunotherapy , or a combination of these. Stage 4 4 With Stage IV kidney cancer, the main tumor has grown outside the kidney, or the cancer has spread to other parts of the body such as distant lymph nodes or other organs. Treatment of Stage IV kidney cancer depends mainly on how extensive the cancer is and on a person’s general health. For most people with Stage IV kidney cancer, medicines such as immunotherapy and targeted drugs are the main treatments (see below). But in some cases, surgery may still be a part of treatment. While it’s not common, sometimes the main tumor appears to be removable and there is only limited spread to another area (such as to one or a few spots in the lungs). In these situations, surgery to remove both the kidney and the metastasis (the outside area of cancer spread) may be an option if a person is in good enough health. Other options to treat the metastatic tumors might include ablative treatments or radiation therapy . If all of the tumors are removed (or destroyed), additional (adjuvant) treatment with the immunotherapy drug(s) might be considered. If the kidney tumor can be removed but the cancer has spread extensively elsewhere, treatment options might include: Removing kidney with the tumor first. This type of surgery (known as a cytoreductive nephrectomy) isn’t recommended for most people, but it might be an option for otherwise healthy people in a low-risk group . Surgery is then followed by drug treatments for most people. Giving drug treatments (immunotherapy and/or targeted drugs) first. This is likely to be preferred for most people, even if it looks like the cancer in the kidney can be removed. For some people, if the cancer shrinks a lot with this treatment, surgery, ablative treatments , or radiation therapy might be options to try to remove or destroy any remaining tumors. If the kidney tumor isn’t removable If the kidney tumor can’t be removed, the first treatment is usually with medicines such as immunotherapy and/or targeted therapy drugs. Often, one of each type of drug is part of the first treatment. Which ones are used depends to some extent on if the cancer is a clear cell RCC or a non-clear cell RCC. If one treatment doesn’t work (or stops working), another one can often be tried. For some less common types of non-clear cell RCC, such as collecting duct RCC or renal medullary carcinoma, chemotherapy is often the first treatment. While it’s not common, sometimes the first treatment might shrink the tumors enough so that surgery , ablative treatments , or radiation , might be options to try to get rid of any remaining tumors. In other situations, surgery or other treatments might be used to help relieve symptoms from the cancer, such as pain or bleeding, rather than trying to get rid of the cancer completely. This type of treatment is called palliative therapy. If you have advanced kidney cancer (stage IV) and your doctor suggests surgery, ablation, or radiation, be sure you understand what the goal of the treatment is. No matter what type of treatment you’re getting, having your pain controlled can help you maintain your quality of life. Treating the cancer itself can often help with this. Medicines to relieve pain can also be helpful, and they will not interfere with your other treatments. Controlling any pain you have can often help you be more active and continue your daily activities. Because advanced kidney cancer is very hard to cure, clinical trials of new combinations of targeted therapy drugs, immunotherapy, or other new treatments are also options. Treating Recurrent Kidney Cancer Cancer is called recurrent when it comes back after treatment. Recurrence can be local (near the area of the original tumor), or it may be in distant parts of the body. Treatment of kidney cancer that comes back (recurs) after initial treatment depends on where it recurs and what treatments have been used, as well as a person’s health and wishes for further treatment. Local recurrence For cancers that recur near the area of the original kidney tumor after surgery, further surgery, other localized treatments, or radiation might be options. Even if not all of the cancer can be removed or destroyed, these treatments might still help relieve symptoms in some people. Other treatment options will most likely include immunotherapy and/or targeted therapy drugs. Clinical trials of new treatments are an option as well. Distant recurrence Kidney cancer that recurs in distant parts of the body is treated like stage IV cancer (see above). Your options will depend on where the cancer is; if it’s thought to be removable or not; which, if any, drugs you received as part of your first treatment (and how long ago you got them); and on your overall health and preferences. For cancers that continue to grow or spread during treatment with immunotherapy or targeted therapy drugs, different drugs still might be helpful. Recurrent cancers can sometimes be hard to treat, so you might also want to ask your doctor about clinical trials. For some people with recurrent kidney cancer, palliative treatments may be the best option. These treatments are intended to help control the cancer and relieve any symptoms it is causing. Options might include radiation therapy, ablative treatments, or even some type of surgery, if a person is healthy enough. Controlling symptoms such as pain is also an important part of treatment at any stage of the disease. Recurrent