Most treatments involving immunotherapy have required removing the cancerous kidney prior to treatment. This removal (nephrectomy) may be beneficial because it :
reduces the amount of tumor tissue in the body
confirms the diagnosis of cancer
may prevent complications from the tumor ie. Bleeding in the urine or pain
allows access to tumors cells and other immune cells for potential experimental treatments
However, nephrectomy is a major operation and may delay immunotherapy which is critical to provide any reasonable hope of long-term survival for the patient with metastatic RCC. In some cases, immunotherapy may be given first to shrink a kidney tumor and make it easier to remove. Since there is no guarantee that the tumor will shrink, this approach should be reserved for patients with metastatic RCC.
It has not yet been determined whether nephrectomy should be performed before immunotherapy or whether it is better to wait until a response to immunotherapy occurs before undergoing nephrectomy. Experimental trials are being directed to answer this question.
