Stage IV RCC - 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.
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Treatment of stage IV kidney cancer depends mainly on how extensive the cancer is and on a person’s general health.
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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 and Treatment
Surveillance
Stage IV - (High Risk)*
3 months post op
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CT or MRI with contrast of abdomen/pelvis
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Chest x-ray or CT
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Basic Metabolic Panel (BMP)
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then,
4 month intervals for 2 years
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(same testing as above)
then,
>2 years at 6 month intervals (years 3 to 5 after surgery)
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(same testing as above)
then,
> 5 years - Annually
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(same testing as above)​​
Treatment
*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 (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.
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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.
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