If you have metastatic renal cell carcinoma (RCC), it means your cancer has spread outside of your kidneys, and possibly to other parts of your body. Metastatic RCC is also called advanced RCC.

Once renal cell cancer has spread, it’s harder to treat. There are still many options for slowing the cancer and prolonging your life.

The main options for treating this type of cancer are:

  • surgery
  • immunotherapy
  • targeted therapy
  • radiation therapy
  • chemotherapy

Discuss all your options with your doctor before deciding on a treatment. Make sure you know the benefits and risks of each treatment.


Surgery is performed to remove as much of the tumor as possible. It’s often used to treat cancers that haven’t yet spread outside of the kidney. Surgery can also treat late-stage cancers.

Radical nephrectomy is the main surgery used to treat advanced RCC. During this procedure, the doctor removes the affected kidney. The adrenal gland close to the kidney, fat around the kidney, and nearby lymph nodes are also removed.

If your cancer hasn’t spread much outside of your kidney, surgery might offer a cure. If your cancer has spread, you’ll also need treatments like targeted therapy and immunotherapy to kill cancer cells that are in other parts of your body.


Immunotherapy, or biologic therapy, is a treatment that helps your immune system attack the cancer. Immunotherapy uses a few different drugs:


Interleukin-2 (IL-2, Proleukin) is a man-made copy of proteins called cytokines that your immune system makes naturally. Cytokines activate your immune system to attack and kill the tumor cells. You get this treatment as a shot under your skin or through an IV into a vein.

Side effects include:

  • low blood pressure
  • fluid in the lungs
  • kidney damage
  • fatigue
  • bleeding
  • chills
  • fever

Interferon alpha

Interferon alpha stops tumor cells from dividing and slows the growth of cancer cells. It comes as a shot. Usually, interferon is given with another drug, such as bevacizumab (Avastin), to help it work better.

Side effects of interferon include:

  • flu-like symptoms
  • nausea
  • fatigue

Checkpoint inhibitors

Checkpoint inhibitors are drugs that help your immune system find cancer. Usually, your immune system uses a system of “checkpoints” to tell its cells apart from harmful cells like cancer.

Cancer can sometimes use these checkpoints to hide from your immune system. Checkpoint inhibitors turn off the checkpoints so cancer can’t hide.

Nivolumab (Opdivo) is a checkpoint inhibitor. You get it through an IV.

Side effects include:

  • rash
  • fatigue
  • diarrhea
  • abdominal pain
  • trouble breathing
  • nausea
  • headache

Targeted therapy

Targeted therapies go after the substances in cancer cells that help them multiply and survive. This treatment kills cancer without damaging healthy cells. Targeted therapies for RCC include:

Anti-angiogenesis therapy. Tumors need a blood supply to grow and survive. This treatment cuts off new blood vessel growth to cancer.

The drug bevacizumab (Avastin) works by blocking the protein VEGF, which helps tumors grow new blood vessels. You get it as an infusion through a vein.

Side effects include:

  • fainting
  • appetite loss
  • heartburn
  • diarrhea
  • weight loss
  • mouth sores

A tyrosine kinase inhibitor (TKI) will stop new blood vessel growth to tumors by targeting proteins called tyrosine kinases. Examples of this type of drug include:

  • cabozantinib (Cabometyx)
  • pazopanib (Votrient)
  • sorafenib (Nexavar)
  • sunitinib (Sutent)

TKIs come as a pill that you take once a day. Side effects include:

  • nausea
  • diarrhea
  • high blood pressure
  • pain in your hands and feet

mTOR inhibitors

Mechanistic target of rapamycin (mTOR) inhibitors target the mTOR protein, which helps renal cell cancer grow. These drugs include:

  • everolimus (Afinitor), which comes as a pill
  • temsirolimus (Torisel), which you get through an IV

Side effects include:

  • mouth sores
  • rash
  • weakness
  • appetite loss
  • fluid buildup in the face or legs
  • high blood sugar and cholesterol

Radiation therapy

Radiation uses high-energy X-ray beams to kill cancer cells. In advanced RCC, it’s often used to relieve symptoms like pain or swelling. This kind of treatment is called palliative care. You might also get radiation after surgery to kill cancer cells left behind.

Side effects of radiation include:

  • skin redness
  • fatigue
  • diarrhea
  • stomach upset


Chemotherapy uses powerful drugs to kill cancer cells. It’s called a systemic treatment, which means it kills cancer cells wherever they have spread to in your body.

This treatment usually doesn’t work very well on renal cell carcinoma. However, your doctor might recommend that you try it if immunotherapy and other treatments haven’t worked.

Chemotherapy is taken as an oral pill, or through a vein. It is given in cycles. You get the medicine for a few weeks, and then rest for a period of time. You typically need to take it every month or every few months.

Side effects of chemotherapy include:

  • hair loss
  • appetite loss
  • fatigue
  • mouth sores
  • nausea and vomiting
  • diarrhea or constipation
  • increased risk for infections

What to expect

In general, late-stage renal cell cancer has a poorer outlook than earlier stage cancer. The five-year survival rate for stage 4 renal cell carcinoma is 8 percent, according to the American Cancer Society. Yet, this statistic doesn’t tell the whole story.

Everyone with kidney cancer is different. Your outlook depends on how aggressive your cancer is, where it has spread, which treatment you get, and your overall health.

New treatments like immunotherapy and targeted therapy are improving the outlook for people with advanced renal cell cancer. Your doctor can more accurately tell you what to expect.