Who determines what kind of treatment a kidney cancer patient receives?

Ultimately, the patient always decides in my book. This requires lengthy explanations of the risks and benefits of treatment options. I can tell you as a chemotherapy expert (medical oncologist) that chemotherapy works very poorly in renal carcinomas and is used as a last resort. The best results are obtained with surgery. You and your husband will need to discuss this in detail with your urological surgeon. If DeniseDDS sees this, she may have some added input. She is exceptional good with urological malignancies. Personally, I would not ' hold my punches ' surgically. This kind of malignancy is highly fatal if not removed completely when it is localized. http://en.wikipedia.org/wiki/Renal_cell_carcinoma

A discussion with the urologist going over the options is of course very important, and there are many factors determining which options are the most viable. A 3.4 cm tumor is smallish but on the high end of being small. Often RCC tumors at 4cm+ will require surgery as the best treatment. There are factors such as the location of the tumor ie. has it penetrated the kidney wall? Also one must look at the overall kidney functioning ie. is the other kidney working well? Also, how old is the patient? Is the patient a good candidate for surgery? Is it a high or low grade cancer? I had my tumor - a 10.5cm tumor - removed by laparscopic surgery; my surgeon was likely the best laparascopic surgeon in the country/world and has pioneered the procedure to a great degree ie. I felt very confident in him doing a proper laparscopic surgery. All surgeons are not equal in performing that procedure. Yet, my urologist tended to underrate the stage of my cancer. It 's a stage 4/grade 4- and the survivor rates are poor - certainly poorer than a stage 1 which can be cured via surgery. My oncologist is a John Hophkin grad. and we decided to wait up to 6mos. for a likely recurrance which we guessed was likely only a 20% chance of 6mos without a recurrance. My recurrance was about 5mos later in the upper arm bone, and I had it removed. A stage 4 RCC 5yr.survival rate IS ABOUT 5-15%. Some clinicians will say it's lower ie. practicallly an immediate death sentence. That's why it's important to get a 2nd opinion, and why it's good to seek out an oncologist who's a fighter and sensative rather than one that treats you like a lab rat and likes the prestige of the 'study.' It's best to fight the disease rather than get hit and pushed down by a statistician. The requrements of being a registrar are really low ie. online courses...and often the person tends to get carried away with a rubber stamp authoritarian mentality. Some of the prominent hospitals focus a lot on maintaining sophisticated cancer support groups ie. I know one called courageous companions that is local that has been doing good quality work. They can be of great help. Also a laparascopic surgery is really efficient and the recovery time is quick. When I hear Kidney Cancer, I generally favor surgery because it can offer 'cure' and even in later stages it can 'extend life.' Statistically, I'm already supposed to be dead, and I've met stage 4 kidney cancer 10 year survivors. It 's the fight of one's life, and it might also be one's death - but you will call the shots. I would say pick a physician that respects you with true honest humane wisdom your choice to fight and have a high quality of life. You're the boss. You are a human being - not a number.