Hi, It is sad to note that your aunt is going through an advanced stage of metastatic renal cell cancer. Evertor (Everolimus) is a mTOR inhibitor drug which is known to control the disease after first line drugs like sunitinib & pazopanib fail to act on the disease. The drug is reasonably toxic in the sense it has multi-organ side effect profile but most of these side effects are not very severe. There are tips to manage side effects well of this drug which you can go through in the following link. http://www.afinitor.com/global/side-effect-management.jsp More concerning in your aunt s case however is that the disease seems to be progressing despite everolimus therapy as she has persistent/worsening symptoms. The gross disease present in her would cause the pain she is having at the moment as the tumor tends to involve the surrounding organs. I cannot reason out why she has urinary blockage though. i recommend you to consult a Uro-oncologist or a urologist to ensure she is not in renal failure causing decreased urinary output. Her pain can be managed better after her doctor ascertains the exact cause of pain. Palliative/pain management specialists are available who could mix/match medications to keep her comfortable with minimal residual pain and minimal side effects. Nerve blocks, palliative radiation(4-8 doses), angio-embolization and radio-pharmaceutical therapy (with strotium, samarium) can be employed after careful consideration of your aunt s needs. the urgent need of the hour though is to make sure Everolimus is working on her. if not, she should be considered for treatment with other drugs like Temsirolimus or Bevacizumab with interferons. I feel that she truly is an advanced metastatic cancer patient with limited options left but i strongly believe we could palliate her symptoms to a large extent to offer her good quality of life as long as she is around. Best Wishes, Srivatsa