title: Strategies of management for advanced or recurrent kidney, adrenal, and miscellaneous genitourinary cancers.
abstract: To formulate reasonable strategies of management requires critical appraisal of all available treatments and determination of the goals of therapy, which may be definitive, investigative, or palliative. Definitive therapy is given to eradicate all known disease in patients without clinically apparent metastases. Investigative therapy has the same intent but there is less assurance of success because therapy is untested or inconsistently effective; surgery for patients with metastatic disease and all protocols for chemohormonal therapy, immunotherapy, and biologic response modifiers are examples. Palliative therapy intends to relieve but not cure, a most worthwhile goal in patients whose comfort and sense of well-being are so often threatened. Strategies for palliation include surgery, irradiation, embolization/infarction, chemotherapy, hormonal therapy, and observation with only symptomatic relief. The last may be optimal for some patients since potential benefits must always outweigh the expected morbidity for therapy to be appropriate.
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D009361:Neoplasm Invasiveness / Q000601:surgery; D010166:Palliative Care; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000601:surgery; D012611:Scrotum / Q000601:surgery; D014565:Urogenital Neoplasms / Q000601:surgery*