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Answer 4
  1. The patient should undergo nephrectomy. Nephrectomy can help manage symptoms caused by the primary tumor. Because the patient is experiencing hematuria, surgery would be the fastest way to relieve her symptoms in preparation for systemic therapy for metastatic disease. Selected patients with solitary or a limited number of distant metastases may achieve prolonged survival with nephrectomy and surgical resection of the metastases.3,4 The operative risk in this patient is low, and most patients recover from surgery within 1 week. Currently, there are more effective first-line therapies for renal cell carcinoma than interferon.1

    1. Cohen HT, McGovern FJ. Renal-cell carcinoma. N Engl J Med 2005;353:2477-90.

    3. Pfannschmidt J, Hoffmann H, Muley T, et al. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 2002; 74:1653-7.

    4. Piltz S, Meimarakis G, Wichmann MW, et al. Long-term results after pulmonary resection of renal cell carcinoma metastases. Ann Thorac Surg 2002;73:1082-7.

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