Treatment options for kidney cancer

Your treatment depends on factors such as the size of the cancer and if it has spread away from your kidney. You might have one or more treatments. These may include surgery and targeted and immunotherapy cancer drugs.

Deciding what treatment you need

Your doctor and other health professionals meet to discuss the treatments suitable for you. This is called the multidisciplinary team (MDT).

Members of the team specialise in different areas of kidney cancer treatment and support. The team usually includes a:

• specialist surgeon (urologist)
• cancer specialist doctor (oncologist)
• a specialist in scans and X-rays (radiologist)
• a specialist in looking at cells under the microscope (pathologist)
• specialist nurse
• doctor who specialises in symptom control

The treatments suitable for you depend on factors including:

• your general health and fitness
• the size of the cancer and where it is in your kidney
• whether the cancer has spread into the lymph nodes close to your kidney
• whether the cancer has spread to another part of your body

Your doctor then discusses the treatment options with you, including the benefits and possible side effects.

You may find it helpful to talk to your specialist nurse about any worries you have about the treatments before you make your decision.

Some people also find it helpful to talk to other people who have had kidney cancer. Your specialist nurse can tell you about any support groups in your area. 

Treatment overview

If the cancer is small you might not need treatment straight away. Instead, your doctor monitors it with regular scans. This is called active surveillance. It's usually for people who aren't able to have surgery. For example, they may be older or have other health conditions.

The main treatments for kidney cancer are:

• surgery

• cryotherapy

• microwave or radiofrequency ablation

• blocking the blood supply to the cancer (renal arterial embolisation)

• targeted or immunotherapy cancer drugs

• radiotherapy

Surgery

Surgery is the main treatment for kidney cancer that hasn't spread to another part of your body.  The surgeon may remove part or all of your kidney.

You might also have surgery for cancer that has spread (advanced cancer). This is to relieve symptoms like pain or blood in your urine.

Cryotherapy

Cryotherapy (or cryoablation) kills cancer cells by freezing them. Your doctor puts a needle through your skin into the kidney and freezes the cancer cells with a cold gas. You may have this treatment if you have a small cancer in the kidney.

Microwave or radiofrequency ablation

Microwave or radiofrequency ablation uses heat to kill cancer cells. Your doctor puts a needle through your skin into the kidney and heats the cancer cells with microwaves or radiofrequency energy. You might have this type of treatment if you have a small cancer in your kidney. Or if you have several cancers in one or both kidneys.

Renal artery embolisation

Blocking the blood supply for kidney cancer is called renal artery embolisation. Your doctor might block the blood supply to just the cancer or the whole kidney. This slows down the growth of the cancer and can improve symptoms, such as pain.

You might have this treatment if you aren’t able to have surgery and the cancer is causing symptoms.

Targeted or immunotherapy cancer drugs

Targeted cancer drugs target the differences between cancer cells and normal cells that help them grow and survive. Immunotherapy uses your immune system to fight cancer.

You may have an immunotherapy drug if you've had surgery to remove the cancer but there's a higher chance of it coming back. You have it into your bloodstream every 3 to 6 weeks for up to a year.

Your doctor will tell you if they think there is a higher chance of the cancer coming back. They will also talk to you about how often you have the treatment and for how long.

Kidney cancer caused by von Hippel-Lindau disease

People with a rare inherited condition called von Hippel-Lindau disease (VHL) have an increased risk of renal cell carcinoma (RCC). RCC is a type of kidney cancer.

If they develop RCC due to VHL they may have treatment with a targeted cancer drug. This is called belzutifan. They may have this treatment if they:

• are not able to have the cancer removed
• do not want surgery to remove the cancer

Targeted and immunotherapy drugs for advanced kidney cancer

You may also have targeted and immunotherapy drugs if you have advanced kidney cancer. This might be:

• one or two targeted cancer drugs
• one or two immunotherapy drugs
• a targeted cancer drug with an immunotherapy drug

There are a number of different targeted or immunotherapy drugs you may have. The aim is to control the cancer and relieve symptoms.

Radiotherapy

Radiotherapy uses high energy rays similar to x-rays to destroy cancer cells. You may have it to help control the symptoms of advanced kidney cancer. The type of radiotherapy and the number of treatments you have depends on where the cancer has spread to.

You have radiotherapy in specialist cancer centres so you may need to travel for your treatment.

Treatment by stage

Treatment for stage 1, 2 or 3 kidney cancer

Surgery is the main treatment for stage 1,2 or 3 kidney cancer. 

If the cancer is smaller than 4cm and you are older or have lots of other health problems, your doctor might suggest you don't have treatment at first. They will monitor you closely instead.

Stage 1 and 2 cancers that are contained in the kidney are often cured with surgery.  

Stage 3 kidney cancers are called locally advanced. This means they have grown outside of the kidney but not to areas far away from it. They can sometimes be cured if your surgeon can remove all of the cancer. 

If there's a higher chance of the cancer coming back you may have an immunotherapy drug called pembrolizumab after surgery.

Sometimes your doctor may recommend another treatment instead of surgery. This might be:

• cryotherapy

• microwave or radiofrequency ablation

• renal arterial embolisation

Your doctor will discuss with you what treatment they think is best.

Stage 4 kidney cancer

Stage 4 kidney cancer means the cancer has spread to another part of the body. It is also called advanced kidney cancer.  Where the cancer has spread to is called a secondary cancer or metastasis. Sometimes, the cancer may already be advanced when you are first diagnosed.

Your doctor may recommend surgery if the cancer hasn’t spread to too many other places. And if you’re well enough to recover from the operation.

If all the cancer is removed with surgery, you might have immunotherapy afterwards. This is to reduce the chance it coming back.

If you can’t have surgery, you might have treatment with targeted or immunotherapy cancer drugs. There are several different types. These drugs can often stop or slow the growth of the cancer.

Other possible treatments include:

• cryotherapy

• microwave or radiofrequency ablation

• renal artery embolisation

• radiotherapy

If kidney cancer comes back

After you’ve had treatment for kidney cancer, you will have regular appointments with your doctor. These are to see how you are after the treatment. And to check if the cancer has come back. 

Unfortunately, cancer can sometimes come back in the kidney area. If you've already had part of your kidney removed, you might have more surgery to remove the rest of your kidney.

If you haven’t had surgery, and you are well enough, you may have your kidney removed. This can get rid of the cancer completely for some people.

If the cancer comes back in another part of the body, your treatment depends on where the cancer is. Sometimes you may have surgery to remove the secondary cancer. Although this is unlikely to cure the cancer it can help relieve symptoms.

You normally have targeted or immunotherapy cancer drugs if the cancer has come back in another part of the body. You might also have them if you can’t have surgery. The treatment aims to stop the cancer from growing and keep it under control.

Clinical trials

Doctors and researchers do trials to make existing treatments better and develop new treatments. Your doctor might ask if you’d like to take part in a clinical trial.