So what "process" does a doctor follow to determine the appropriate treatment for kidney cancer?  I asked Memorial Sloan Kettering's Dr. James Hsieh about this and he sent the attached graphic.  For those without 20/40 vision, I describe the graphic here.

The first major decision is to determine if the tumor is primary (located in just the kidney) or metastatic (has spread beyond the kidney).

Primary Kidney Tumor

If it is just in the kidney, the tumor is

• "Resected" - i.e. removed, which necessitates the partial or total removal of the kidney.
• Examined by "Pathology" - i.e. examined under a microscope to determine what "type" it is.
• "Targeted Cancer Genomics" - i.e. examined at the sub-cellular or "DNA" level.  For the patient, this helps determine how long the tumor has been mutating, and so what the chances are that it has metastasized.  For the researcher, it provides information for further research..

Metastatic Kidney Tumor

If the tumor has spread beyond the kidney, the first three steps are still followed; i.e. the tumor is 

• "Resected" - i.e. removed, which necessitates the partial or total removal of the kidney.
• Examined by "Pathology" - i.e. examined under a microscope to determine what "type" it is.
• "Targeted Cancer Genomics" - i.e. examined at the sub-cellular or "DNA" level.  For the patient, this helps determine how long the tumor has been mutating, and so what the chances are that it has metastasized.  For the researcher, it provides information for further research..

However, in the case of metastasis, more steps are followed.  i.e.

• "Therapeutic Decision Based on Pathology and Genomics" - A clinical Trial is chosen in conjunction with the patient based on the pathology and genomic exams.
• "Xenografts, Cell Lines, Drug Screen" - The Memorial Sloan Kettering researcher tests a variety of drugs ("Drug Screening") on tumor cells transfered to petri dishes (Cell lines) and implanted in mice (Xenografts).
• "Genomic Correlation" - The Memorial Sloan Kettering researcher relates the effectiveness of the drugs to the tumors' genetic sequence.