What are the guideline sources, guidelines and references for Renal cell carcinoma ?
Guideline sources The following summarized guidelines for the evaluation and management of renal cell carcinoma (RCC) are prepared by our editorial team based on guidelines from the Canadian Urological Association (CUA 2023; 2018), the Canadian Kidney Cancer Forum (CKCF 2023; 2017; 2014), the European Association of Urology (EAU 2022), the American Society of Clinical Oncology (ASCO 2022; 2017), the American Urological Association (AUA 2021), and the European Society of Medical Oncology (ESMO 2021; 2016). 1 2 3 4 5 6 7 8 9 10 11 12 CalculatorEastern Cooperative Oncology G CalculatorIMDC risk model for metastatic r CalculatorKarnofsky Guidelines https://web.pathway.md/diseases/recl98pr2fnRrwIxk 1/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway 1. Screening and diagnosis Diagnosis: Compare tissue acquired outside the site of primary disease to the primary histology for the diagnosis of metastatic clear cell RCC. Assess common markers of clear cell RCC including paired box gene 8 and carbonic anhydrase IX. A Consider establishing the diagnosis of metastatic clear cell RCC radiographically in selected circumstances, such as settings with a prior diagnosis of RCC, when metastatic tissue is not readily accessible by biopsy or when RECIST 1.1 measurable disease is evident, especially within a year of the initial diagnosis. C 2. Classification and risk stratification Classification systems: Use the current TNM classification system. A Use the WHO/ISUP grading system and classify RCC type. A Prognostic models: As per EAU 2022 guidelines: Use prognostic models in patients with localized and metastatic disease. A Do not obtain routine molecular markers to assess prognosis. D As per CUA 2018 guidelines, use tumor grade, local extent of the primary tumor, presence of nodal metastasis, and histological subtype as predictors of the disease relapse. B Show 3 more 3. Diagnostic investigations Laboratory tests: As per AUA 2021 guidelines: Obtain a comprehensive metabolic panel, CBC, and urinalysis in patients with suspected renal malignancy. B Assign CKD stage in patients with a solid or Bosniak III or IV complex cystic renal mass based on GFR and degree of proteinuria. E Imaging for staging: As per EAU 2022 guidelines, obtain chest and abdominal multi-phasic contrast-enhanced CT for the diagnosis and staging of renal tumors. A Show 5 more As per AUA 2021 guidelines: Obtain high-quality, multiphase, cross-sectional abdominal imaging to optimally characterize and clinically stage the renal mass in patients with a solid or complex cystic renal mass. https://web.pathway.md/diseases/recl98pr2fnRrwIxk 2/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway Assess tumor complexity, degree of contrast enhancement (where applicable), and presence or absence of fat in the characterization of the renal mass. B Obtain chest imaging to evaluate for possible thoracic metastases. B Genetic testing: As per EAU 2022 guidelines: Obtain genetic testing in 46 years old patients with any of the following: bilateral or multifocal tumors first- or second-degree relative with RCC close blood relative with a known pathogenic variant specific histologic characteristics suggesting a hereditary form of RCC. A Refer patients with suspected hereditary kidney cancer to a cancer geneticist or a comprehensive clinical care center. A 4. Diagnostic procedures Renal biopsy: As per EAU 2022 guidelines, perform preoperative renal mass biopsies in patients with unclear kidney lesions before management. B Show 5 more As per AUA 2021 guidelines, counsel patients regarding rationale, positive and negative predictive values, potential risks, and nondiagnostic rates when considering undergoing renal mass biopsy. B Show 4 more 5. Medical management Management of local/locoregional disease, watchful waiting: As per EAU 2022 guidelines: Consider offering active surveillance in patients with Bosniak type III cysts. C Consider offering active surveillance in frail and/or comorbid patients with small renal masses. C As per AUA 2021 guidelines, consider offering active surveillance with the potential for delayed intervention for initial management in patients with a solid renal mass < 2 cm or predominantly cystic complex masses. C Show 3 more As per ASCO 2017 guidelines, offer active surveillance as an initial management option in patients with significant comorbidities and limited life expectancy. B As per CKCF 2014 guidelines, consider offering active surveillance with serial imaging (ultrasound, CT, or MRI), initially at 3-6 months and then yearly with a duration of follow-up https://web.pathway.md/diseases/recl98pr2fnRrwIxk 3/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway tailored to individual patient risk factors, in elderly or frail patients with stage T1aN0M0 RCC. E Management of local/locoregional disease (neoadjuvant therapy): do not offer neoadjuvant therapy before planned surgical resection in patients with locally advanced disease outside the context of a clinical trial. D Management of local/locoregional disease, tumor resection: As per EAU 2022 guidelines, perform surgery to achieve cure in patients with localized renal cell cancer. A Show 6 more As per AUA 2021 guidelines, perform partial nephrectomy for the management of patients with cT1a renal mass, if intervention is indicated, to minimize the risk of CKD or CKD progression and for favorable oncologic outcomes, including excellent local control. B Show 10 more As per ASCO 2017 guidelines: Offer partial nephrectomy as the standard treatment for small renal masses in patients with a tumor amenable to this approach. B Reserve radical nephrectomy for small renal masses only for patients with a tumor of significant complexity not amenable to partial nephrectomy or if partial nephrectomy may result in unacceptable morbidity even when performed at centers with expertise. Consider referring patients to a surgeon and a center with experience in partial nephrectomy. B As per ESMO 2016 guidelines, perform partial nephrectomy in patients with T1 tumors if negative margins are obtained and the risk of morbidity is acceptable. B Show 2 more As per CKCF 2014 guidelines, perform partial nephrectomy (via an open, laparoscopic, or robotic approach) in patients with stage T1aN0M0 RCC. Perform pure or robot-assisted laparoscopic partial nephrectomy (transperitoneal or retroperitoneal) by experienced surgeons. E Show 4 more Management of local/locoregional disease, lymphadenectomy: As per EAU 2022 guidelines: Remove clinically enlarged lymph nodes during nephrectomy for staging, prognosis, and follow-up implications. B Do not perform extended lymph node dissection in patients with organ-confined disease. D As per AUA 2021 guidelines, perform lymph node dissection involving all clinically positive nodes for staging purposes in patients undergoing surgical excision of a renal mass with clinically concerning regional lymphadenopathy. E As per ESMO 2016 guidelines, do not perform routine lymph node dissection during radical nephrectomy. D As per CKCF 2014 guidelines: https://web.pathway.md/diseases/recl98pr2fnRrwIxk 4/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway Do not perform routine lymphadenectomy during radical or partial nephrectomy in patients with clinical N0 disease. D Perform lymphadenectomy in patients with clinical N1M0 disease. E Management of local/locoregional disease, adrenalectomy: As per EAU 2022 guidelines, do not perform ipsilateral adrenalectomy if there is no clinical evidence of invasion of the adrenal gland. D As per AUA 2021 guidelines, perform adrenalectomy during surgical excision of a renal mass if imaging and/or intraoperative findings suggest metastasis or direct invasion of the adrenal gland. B As per ESMO 2016 guidelines, do not perform routine adrenalectomy during radical nephrectomy. D As per CKCF 2014 guidelines, preserve the ipsilateral adrenal gland at the time of nephrectomy if it appears normal on imaging and there is no sign of direct tumor invasion. E Management of local/locoregional disease, ablation: As per EAU 2022 guidelines, perform embolization in patients unfit for surgery presenting with massive hematuria or flank pain. B Show 4 more As per AUA 2021 guidelines, consider offering thermal ablation as an alternative approach in patients with cT1a solid renal masses < 3 cm in size. Prefer percutaneous techniques over surgical approaches whenever feasible to minimize morbidity in patients electing thermal ablation. C Show 3 more As per ASCO 2017 guidelines, consider offering percutaneous thermal ablation if complete ablation of the tumor is achievable. Perform a biopsy before or at the time of ablation. C As per ESMO 2016 guidelines, consider offering ablative treatment options in patients with small cortical tumors ( 3 cm) and age > 70 years, high surgical risk, solitary kidney, compromised renal function, hereditary RCC, or multiple bilateral tumors. C As per CKCF 2014 guidelines, consider offering probe ablation by radiofrequency or cryotherapy in patients with stage T1aN0M0 RCC at high surgical risk. Perform a biopsy before or at the time of ablation. E Management of local/locoregional disease, adjuvant therapy: As per CKCF 2023 guidelines, inform parents with resected clear cell RCC at elevated risk of recurrence about the potential role of adjuvant therapy and offer a referral to medical oncology. Offer adjuvant therapy only after a full resection of clear cell RCC (localized or M1 no evidence of disease). Obtain staging with cross-sectional imaging of the chest/abdomen/pelvis before starting adjuvant therapy. E Show 6 more As per EAU 2022 guidelines, offer adjuvant pembrolizumab in patients with clear cell RCC following surgery with curative intent with a risk of recurrence. B https://web.pathway.md/diseases/recl98pr2fnRrwIxk 5/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway Show 2 more As per AUA 2021 guidelines, counsel patients with high-risk or locally advanced, fully resected renal cancer about the risks/benefits of adjuvant therapy and encourage participation in adjuvant clinical trials, facilitated by medical oncology consultation when needed. B As per ESMO 2021 guidelines, consider offering adjuvant pembrolizumab in patients with intermediate- or high-risk operable clear cell RCC after careful counseling regarding immature overall survival and potential long-term adverse events B . Start treatment within 12 weeks of surgery and continue for up to 1 year. Show 4 more Management of advanced/metastatic disease (general principles): Provide access to multidisciplinary care, including kidney cancer specialists and health professionals with expertise in supportive care. Provide information on community resources for patients and caregivers. E Consider enrolling patients with advanced or metastatic RCC in clinical trials as the first option. E Management of advanced/metastatic disease, watchful waiting: As per ASCO 2022 guidelines, consider offering an initial active surveillance strategy in selected patients with metastatic clear cell RCC. B As per ESMO 2021 guidelines, consider offering surveillance, after careful consideration, in a small subset of patients with advanced clear cell RCC. C As per CKCF 2017 guidelines, consider offering observation in selected patients with slow- growing, low-volume, and/or asymptomatic advanced/metastatic RCC. E As per CKCF 2014 guidelines, consider offering active surveillance with serial imaging (ultrasound, CT, or MRI), initially at 3-6 months and then yearly with a duration of follow-up tailored to individual patient risk factors, in elderly or frail patients with RCC. Obtain annual CXRs to screen for pulmonary metastases. E Management of advanced/metastatic disease, cytoreductive nephrectomy: As per ASCO 2022 guidelines, consider offering cytoreductive nephrectomy in selected patients with metastatic clear cell RCC. B As per EAU 2022 guidelines, do not perform cytoreductive nephrectomy in MSKCC poor-risk patients. D Show 5 more As per CKCF 2017 guidelines, consider performing cytoreductive nephrectomy in appropriately selected patients presenting with de novo metastatic RCC, ideally after a multidisciplinary discussion. E As per CKCF 2014 guidelines, perform radical nephrectomy with resection of adjacent organs if feasible in patients with stage T4N0M0 RCC (local tumor extension to adjacent organs without metastatic disease). E Show 3 more https://web.pathway.md/diseases/recl98pr2fnRrwIxk 6/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway Management of advanced/metastatic disease, clear cell RCC, first-line therapy: As per ASCO 2022 guidelines, stratify all patients with metastatic clear cell RCC requiring systemic therapy in the first-line setting into the following IMDC groups: favorable (0) intermediate (1-2) poor (3+). A Show 4 more As per EAU 2022 guidelines, do not offer chemotherapy in patients with metastatic RCC. D Show 8 more As per ESMO 2021 guidelines, offer VEGF receptor-programmed cell death protein-1 inhibitor- targeted combinations (axitinib-pembrolizumab or cabozantinib-nivolumab) as first-line therapy in patients with advanced clear cell RCC irrespective of the International Metastatic RCC Database Consortium risk groups. A Show 7 more As per CKCF 2017 guidelines, offer targeted therapy as the preferred first-line therapy in patients with advanced/metastatic clear-cell carcinoma. Consider offering high-dose IL-2 in highly selected patients. E Management of advanced/metastatic disease, clear cell RCC, second-line therapy: As per ASCO 2022 guidelines, offer nivolumab or cabozantinib in patients progressing on VEGF receptor TKI monotherapy. A Show 3 more As per EAU 2022 guidelines, offer nivolumab or cabozantinib in patients with immune checkpoint inhibitor-naive, VEGF receptor-refractory clear cell metastatic RCC after 1-2 lines of therapy. A Show 4 more As per ESMO 2021 guidelines: Consider offering sequencing VEGF receptor TKI therapy (agents not previously used) after PD-1 inhibitor-based first-line therapy as the standard of care. C Do not offer immune checkpoint inhibitors after progression on first-line immune checkpoint inhibitor-based therapy. D As per CKCF 2017 guidelines: Offer targeted therapy as second- and subsequent-line therapy in patients progressing on or intolerant to first-line cytokine therapy. E Offer checkpoint inhibition with nivolumab or switch to another targeted agent as second-line therapy in patients with clear cell carcinoma progressing on first-line targeted therapy. Offer enrollment in clinical trials. E Management of advanced/metastatic disease, non-clear cell RCC: As per EAU 2022 guidelines, offer cabozantinib in patients with advanced papillary RCC without molecular testing. B Show 3 more https://web.pathway.md/diseases/recl98pr2fnRrwIxk 7/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway As per ESMO 2021 guidelines, offer cabozantinib as first-line agent for advanced papillary RCC without additional molecular testing. B Show 2 more Management of advanced/metastatic disease, metastasis-directed therapy, general principles: As per ASCO 2022 guidelines: Consider offering definitive metastasis-directed therapies, including surgical resection (metastasectomy), ablative measures, and radiotherapy, in patients with low-volume metastatic RCC. B Do not offer routine subsequent TKIs in patients undergoing complete metastasectomy. D As per EAU 2022 guidelines, obtain confirmatory axial scan of disease status to rule out rapid progressive metastatic disease requiring systemic treatment before performing metastasectomy. B Show 4 more As per CKCF 2014 guidelines, consider performing complete metastasectomy in selected patients with TanyNanyM+ (distant metastases at the time of renal tumor diagnosis) with few surgically resectable metastases. E Management of advanced/metastatic disease, metastasis-directed therapy, bone metastases: As per ASCO 2022 guidelines, offer bone-directed radiotherapy in patients with symptomatic bone metastases from metastatic clear cell RCC. B Show 2 more As per CKCF 2017 guidelines, consider offering bone-modifying agents to decrease skeletal- related events in patients with bone metastases. E Management of advanced/metastatic disease (metastasis-directed therapy, brain metastases): Offer brain-directed local therapy with radiotherapy and/or surgery in patients with brain metastases from metastatic clear cell RCC. A Insufficient evidence to recommend optimal systemic therapy in patients with metastatic clear cell RCC and brain metastases. I Management of advanced/metastatic disease (metastasis-directed therapy, tumor thrombus): resect tumor thrombus if technically feasible in appropriately selected patients, regardless of distant metastases. Perform this operation in a center with experience and an availability of a multidisciplinary team, as this complex procedure have a significant risk of morbidity and mortality. E Management of advanced/metastatic disease, sarcomatoid features: As per CKCF 2023 guidelines, consider offering adjuvant systemic therapy in patients with clear cell RCC with sarcomatoid features. E https://web.pathway.md/diseases/recl98pr2fnRrwIxk 8/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway As per ASCO 2022 guidelines, offer immune checkpoint inhibitor-based combination first-line therapy (ipilimumab plus nivolumab, or alternatively, an immune checkpoint inhibitor plus a TKI) in patients with metastatic clear cell RCC with sarcomatoid features. A As per EAU 2022 guidelines, offer immune checkpoint inhibitor combination therapy in patients with metastatic clear cell RCC with sarcomatoid features. B As per ESMO 2021 guidelines, offer immune checkpoint inhibitor-based therapy over single- agent VEGF receptor TKI in patients with sarcomatoid renal tumors. B 6. Specific circumstances Patients with Bosniak III-IV cysts (risk assessment): assign CKD stage in patients with a Bosniak III or IV complex cystic renal mass based on GFR and degree of proteinuria. E Show 2 more Patients with Bosniak III-IV cysts (biopsy): Consider performing a biopsy in patients with a Bosniak IV cyst if there is a significant solid component amenable to biopsy and if the result may alter management. E Do not perform a biopsy of renal masses without a solid component because of low diagnostic yield. D Patients with Bosniak III-IV cysts, counseling: As per CUA 2023 guidelines, counsel patients with a Bosniak III or IV cyst 3 cm in size considering treatment with thermal ablation about the higher uncertainty surrounding the data on the efficacy and harms of percutaneous thermal ablation treatment compared to surgery. E As per AUA 2021 guidelines: Engage a multidisciplinary team in counseling and considering management strategies in patients with a Bosniak III or IV complex cystic renal mass. E Review the most common and serious urologic and non-urologic morbidities of each treatment pathway and the importance of patient age, comorbidities/frailty, and life expectancy during counseling of patients with a Bosniak III or IV complex cystic renal mass. B Patients with Bosniak III-IV cysts, watchful waiting: As per CUA 2023 guidelines, consider offering active surveillance as the preferred strategy in patients with a Bosniak III or IV complex renal cyst measuring 2 cm in size. C Show 2 more As per AUA 2021 guidelines, offer active surveillance/expectant management in patients with a Bosniak 3/4 complex cystic renal mass when the anticipated risk of intervention or competing risks of death outweigh the potential oncologic benefits of active treatment. Obtain periodic clinical surveillance and/or imaging based on shared decision-making in asymptomatic patients. B Show 2 more Patients with Bosniak III-IV cysts, management: https://web.pathway.md/diseases/recl98pr2fnRrwIxk 9/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway As per CUA 2023 guidelines, consider offering active surveillance or surgery as the preferred strategy in patients with a Bosniak III or IV complex renal cyst measuring 2-4 cm in diameter. C Show 3 more As per EAU 2022 guidelines: Manage patients with Bosniak type III cysts similarly to patients with localized RCC or offer active surveillance. B Manage patients with Bosniak type IV cysts similarly to patients with localized RCC. A As per AUA 2021 guidelines, offer nephron-sparing approaches in patients with a Bosniak III/IV complex cystic renal mass and an anatomic or functionally solitary kidney, bilateral tumors, known familial RCC, preexisting CKD, or proteinuria. B Show 2 more Patients with renal angiomyolipoma: Offer selective arterial embolization or nephron-sparing surgery in patients with angiomyolipoma with any of the following: large tumors female patients of childbearing age inadequate follow-up or access to emergency care persistent pain or acute/repeated bleeding episodes. B Offer systemic therapy in patients with surgically unresectable angiomyolipomas not amendable to embolization or surgery. B Patients with renal oncocytoma: As per EAU 2022 guidelines, offer active surveillance as an acceptable alternative to surgery or ablation in patients with biopsy-proven oncocytoma. B As per CUA 2018 guidelines, do not obtain routine imaging beyond 1 year if pre-treatment biopsy demonstrated oncocytoma and post-ablation imaging shows treatment success. D Patients with renal medullary carcinoma: Perform radical nephrectomy in patients with localized renal medullary carcinoma. B Offer cisplatin-containing chemotherapy regimens (such as cisplatin plus gemcitabine) in patients with renal medullary carcinoma. B 7. Patient education General counseling: engage a multidisciplinary team in counseling and considering management strategies in patients with a solid or Bosniak III or IV complex cystic renal mass. E Show 3 more 8. Preventative measures https://web.pathway.md/diseases/recl98pr2fnRrwIxk 10/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway Primary prevention: Advise the following as primary preventative measures to decrease the risk of RCC: increase physical activity quit cigarette smoking reduce weight in obesity. A 9. Follow-up and surveillance Indications for referral: As per AUA 2021 guidelines: Consider referring patients with a high risk of CKD progression to nephrology, including patients with an estimated GFR < 45 mL/min/1.73 m , confirmed proteinuria, patients with diabetes with preexisting CKD, or whenever estimated GFR is expected to be < 30 mL/min/1.73 m after an intervention. E Consider referring patients with concerns of potential clinical metastasis or incompletely resected disease (macroscopic positive margin or gross residual disease) to medical oncology. C As per CUA 2018 guidelines, consider referring patients with an estimated GFR < 45 mL/min/1.73m or progressive CKD develops after surgery especially if associated with proteinuria. C Surveillance for recurrence, general principles: As per EAU 2022 guidelines, offer intensified follow-up in patients with a positive surgical margin, especially in upstaged pT3a patients. B As per EAU 2022 guidelines, obtain follow-up after treatment of localized RCC based on the risk of recurrence. A Show 4 more As per AUA 2021 guidelines, discuss the implications of the stage, grade, and histology including the risks of recurrence and possible sequelae of treatment in patients undergone intervention for a renal mass. Obtain occasional clinical evaluation and laboratory testing for sequelae of treatment in patients with pathologically-proven benign renal masses. E Show 12 more As per CUA 2018 guidelines, obtain surveillance to detect recurrences and metastases early when they are more likely to be successfully treated. Attempt to identify local and contralateral kidney recurrence (incidence < 2%) early since the majority of these patients can be cured with treatment. B Show 5 more Surveillance for recurrence (low-risk, pT1 tumors): obtain abdominal CT, MRI, or ultrasound at 24 and 60 months. B Show 3 more https://web.pathway.md/diseases/recl98pr2fnRrwIxk 11/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway Surveillance for recurrence (intermediate-risk, pT2 tumors): obtain surveillance with clinical assessment, blood biochemistry, and CXR (or chest CT) every 6 months for 3 years, and annually thereafter. Obtain abdominal CT, MRI, or ultrasound at 12, 24, 36, and 60 months. B Surveillance for recurrence (high-risk, pT3/pT4 and N+ tumors): Obtain surveillance with clinical assessment, blood biochemistry, and CXR (or chest CT) within 3 months after surgery, every 6 months for 3 years, and annually thereafter. Obtain abdominal CT or MRI at 6, 12, 18, 24, 36, and 60 months, and every two years thereafter. B Obtain abdominal CT or MRI at 3 and 6 months, every 6 months for 3 years, and annually thereafter in patients with lymph node-positive disease. B Management of recurrent disease: as per EAU 2022 guidelines, offer local therapy in patients with locally recurrent disease if technically possible and after balancing adverse prognostic features, comorbidities, and life expectancy. B References 1. B. Ljungberg Chair), L. Albiges, J. Bedke et al. EAU Guidelines on Renal Cell Carcinoma. EAU. 2022. Open 2. Antonio Finelli, Nofisat Ismaila, Bill Bro et al. Management of Small Renal Masses: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2017 Feb 20;35 6 668 680. Open 3. Steven C Campbell, Peter E Clark, Sam S Chang et al. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I. J Urol. 2021 Aug;206 2 199 208. Open 4. Ricardo A Rendon, Anil Kapoor, Rodney Breau et al. Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus. Can Urol Assoc J. 2014 May;8 5 6 E398 412. Open 5. T Powles, L Albiges, A Bex et al. ESMO Clinical Practice Guideline update on the use of immunotherapy in early stage and advanced renal cell carcinoma. Ann Oncol. 2021 Dec;32 12 1511 1519. Open 6. W Kimryn Rathmell, R Bryan Rumble, Peter J Van Veldhuizen et al. Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline. J Clin Oncol. 2022 Sep 1;40 25 2957 2995. Open 7. M Neil Reaume, Naveen S Basappa, Lori Wood et al. Management of advanced kidney cancer: Canadian Kidney Cancer Forum CKCF consensus update 2017. Can Urol Assoc J. 2017 Oct;11 10 310 320. Open 8. Escudier B, Porta C, Schmidinger M et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016 Sep;27(suppl 5):v58-v68. Open 9. Patrick O Richard, Philippe D Violette, Bimal Bhindi et al. 2023 UPDATE Canadian Urological Association guideline: Management of cystic renal lesions. Can Urol Assoc J. 2023 Jun;17 6 162 174. Open 10. Wassim Kassouf, Leonardo L Monteiro, Darrel E Drachenberg et al. Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Can Urol Assoc J. 2018 Aug;12 8 231 238. Open 11. Steven C Campbell, Robert G Uzzo, Jose A Karam et al. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline: Part II. J Urol. 2021 Aug;206 2 209 218. Open https://web.pathway.md/diseases/recl98pr2fnRrwIxk 12/13 6/24/23, 2:57 PM Renal cell carcinoma Pathway 12. Aly-Khan A Lalani, Anil Kapoor, Naveen S Basappa et al. Adjuvant therapy for renal cell carcinoma: 2023 Canadian Kidney Cancer Forum consensus statement. Can Urol Assoc J. 2023 May;17 5 E154 E163. Open 13. William P Parker, John C Cheville, Igor Frank et al. Application of the Stage, Size, Grade, and Necrosis SSIGN Score for Clear Cell Renal Cell Carcinoma in Contemporary Patients. Eur Urol. 2017 Apr;71 4 665 673. Open https://web.pathway.md/diseases/recl98pr2fnRrwIxk 13/13