When it comes to kidney cancer, it is easy to think of death. When it comes to death, cancer patients will invariably think of one question: How long will I live? Death is the most serious result that can be caused by advanced cancer. We need to face death bravely and overcome it. To answer this question, today we introduce to you the common metastatic ways of kidney cancer and how to predict the survival time by metastatic sites. What are the ways of metastasis of renal cell carcinoma? 1.Direct spread: Kidney cancer can directly invade and penetrate the perinephric fascia to local spread and infiltrate adjacent tissues and organs, including spleen, pancreas, descending colon, transverse colon, small intestine and abdominal aorta around the left kidney, liver, duodenum, ascending colon and inferior vena cava around the right kidney, as well as the posterior muscles. The cancer thrombus in the inferior vena cava is a very specific local invasion that can even continue all the way upward into the atrium. Usually, the cancer thrombus is continuous with the primary tumor of the kidney itself. 1.Lymphatic metastasis: kidney cancer cells can metastasize along the lymphatic vessels to the hilar and retroperitoneal lymph nodes, and a few can also metastasize to the mediastinum, pelvis and supraclavicular lymph nodes. 3.Hematogenous metastasis: Hematogenous metastasis is more common. Cancer cells invade blood vessels, most commonly lung metastasis, other common sites are bone, liver, brain, pleura, adrenal gland, etc. What are the treatment options for metastatic renal cell carcinoma? There are many treatment options for metastatic renal cell carcinoma. If nephrectomy is not performed, resection of the primary tumor in the kidney may be considered first, followed by systemic systemic therapy including immunotherapy, new targeted therapies or clinical trials. In the case of small solitary lesions in the lung or local recurrence in the kidney, metastasectomy may be considered. Bone metastases with severe pain can be treated with radiation therapy and bisphosphonates. Patients with brain metastases may try gamma knife treatment or whole cranial radiotherapy to reduce neurological symptoms. How to predict the survival time by the metastasis site? In the past, the average survival time for patients with metastatic renal cell carcinoma was 12 to 14 months. However, newer targeted drugs (first-line drugs approved in China are sotan and doxorubicin) can extend this time to about 2 years. It is important to note that 2 years is the average time for a large sample size of patients, and this survival time may vary greatly from a few months to several years for each patient specifically. Here, we share our 8-year experience with sotane-based as well as doxorubicin-targeted therapy at our center, grouped by metastatic site. Pulmonary metastases: 56% of patients come in with pulmonary metastases and this group has the best prognosis, with survival times of more than 40 months abounding. Brain metastases: 4-5% of patients come with brain metastases, and since the brain is functionally important to the body, this group of patients has the worst prognosis, with an average survival time of 1 year. Liver metastases: 10% of patients have liver metastases. Liver metastases have a relatively poor prognosis and progress more rapidly, but are better than brain metastases. Adrenal, bone, and lymph node metastases: The prognosis of this group of patients is moderately optimistic and lies between lung and liver. Of course, there are many factors that can affect the prognosis of patients, such as longer survival time for patients who are old and strong, whose tumors may not affect their lives immediately, and who are mostly able to tolerate various related treatments. Patients with good psychological status tend to survive longer than those who are depressed after suffering a cancerous attack. Also, patients who respond better to treatment tend to survive longer. Therefore, one should build up confidence and actively treat in the face of tumor.