The challenging case of an asymptomatic 63-yr-old man with a large renal cell carcinoma, bilateral adrenal mass, and small pancreatic and pulmonary nodules suspicious for metastases is presented. Treatment strategy is discussed by a surgeon recommending immediate cytoreductive nephrectomy and unilateral adrenalectomy as the first step and a medical oncologist favouring systemic targeted therapy at symptomatic disease progression.
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