American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with small tumors and non-metastatic renal cell carcinoma, which treatment option may be considered?

1. Immediate nephrectomy

2. Active surveillance

3. Radiation therapy

4. High-dose chemotherapy

The correct answer is: Active surveillance

Active surveillance is a treatment strategy that may be considered for patients with small tumors and non-metastatic renal cell carcinoma. This approach involves closely monitoring the tumor without immediate intervention unless there is evidence of progression. Active surveillance is particularly appropriate in cases where the tumor is small, has a low risk of aggressive behavior, and the patient may have comorbidities that make surgery risky. The rationale for choosing active surveillance includes the understanding that many small renal tumors, especially those classified as stage T1a or T1b, may grow slowly or not at all. By opting for active surveillance, clinicians aim to avoid overtreatment and maintain the patient's quality of life while continuing to monitor the tumor through regular imaging and clinical assessments. If there are signs of growth or changes in the tumor characteristics, treatment options can be reconsidered at that time. In contrast, immediate nephrectomy may be overly aggressive for small tumors that are not symptomatic or causing issues, while radiation therapy and high-dose chemotherapy are typically not first-line treatments for renal cell carcinoma, particularly for localized disease. Therefore, the option of active surveillance is supported by current guidelines and clinical practices for managing small, localized renal tumors effectively.