Treatment Choices by Stage for Kidney Cancer

The type of treatment(s) your doctor recommends will depend on the stage of the cancer and on your overall health. This section sums up the options usually considered for each stage of kidney cancer.

Stages I, II, or III

Stage I and II cancers are still contained within the kidney. Stage III cancers have either grown into nearby large veins or have spread to nearby lymph nodes.

These cancers are usually removed with surgery when possible. There are two common approaches:

  • Partial nephrectomy (removing part of the kidney). This is often the treatment of choice in tumors up to 7 cm (a little less than 3 inches) if it can be done.
  • Radical nephrectomy (removing the entire kidney).

The lymph nodes near the kidney may be removed as well, especially if they are enlarged.

If the cancer has grown into nearby veins (as with some stage III cancers), your surgeon may need to cut open these veins to remove all of the cancer. This may require putting you on bypass (a heart-lung machine), so that the heart can be stopped for a short time to remove the cancer from the large vein leading to the heart.

After surgery, some people at high risk of the cancer returning might be helped by getting the targeted drug sunitinib (Sutent) for about a year, which can help lower this risk. Treatment given after surgery is known as adjuvant therapy. Sunitinib can have side effects, so it’s important to talk to your doctor about the benefits and risks.  Clinical trials are also looking at other adjuvant treatments for kidney cancer. Ask your doctor if you are interested in learning more about adjuvant therapies being studied in clinical trials.

If you cannot have kidney surgery because of other serious medical problems, you might benefit from other local treatments such as cryotherapy, radiofrequency ablation, or arterial embolization. Radiation therapy may be another option. These treatments are generally only given when surgery can’t be done. Although these types of treatments can have similar outcomes to surgery as far as the chances of the cancer spreading to other parts of the body, some studies show the cancer might be more likely to come back in the same area.

Active surveillance is another option for some people with small kidney tumors. With active surveillance, the tumor is watched closely (with CTs or ultrasounds) and only treated if it grows.

Stage IV

Stage IV kidney cancer means the cancer has grown outside of the kidney or has spread to other parts of the body such as distant lymph nodes or other organs.

Treatment of stage IV kidney cancer depends on how extensive the cancer is and on the person’s general health. In some cases, surgery may still be a part of treatment.

In rare cases where the main tumor appears to be removable and the cancer has only spread to one other area (such as to one or a few spots in the lungs), surgery to remove both the kidney and the metastasis (the outside area of cancer spread) may be an option if a person is in good enough health. Otherwise, treatment with immunotherapy, one of the targeted therapies, or a combination of the two is usually the first option.

If the main tumor is removable but the cancer has spread extensively elsewhere, removing the kidney may still be helpful. This would likely be followed by systemic therapy, which might consist of one of the targeted therapies, immunotherapy, or a combination of the two. It’s not clear if any one of these therapies or any particular sequence is better than another, although temsirolimus appears to be most helpful for people with kidney cancers that have a poorer prognosis (outlook).

For cancers that can’t be removed surgically (because of the extent of the tumor or the person’s health), first-line treatment is likely to be one of the targeted therapies, immunotherapy, or a combination.

Because advanced kidney cancer is very hard to cure, clinical trials of new combinations of targeted therapies, immunotherapy, or other new treatments are also options.

For some people, palliative treatments such as embolization or radiation therapy may be the best option. A special form of radiation therapy called stereotactic radiosurgery can be very effective in treating single brain metastases. Surgery or radiation therapy can also be used to help reduce pain or other symptoms of metastases in some other places, such as the bones. You can read more about palliative treatment for cancer in Palliative (Supportive) Care or in Advanced Cancer, Metastatic Cancer, and Bone Metastasis.

Having your pain controlled can help you maintain your quality of life. Medicines to relieve pain do not interfere with your other treatments, and controlling pain will often help you be more active and continue your daily activities.

Recurrent cancer

Cancer is called recurrent when it come backs after treatment. Recurrence can be local (near the area of the initial tumor) or it may be in distant organs. Treatment of kidney cancer that comes back (recurs) after initial treatment depends on where it recurs and what treatments have been used, as well as a person’s health and wishes for further treatment.

Local recurrence

For cancers that recur after initial surgery, further surgery might be an option. Otherwise, treatment with targeted therapies or immunotherapy will probably be recommended. Clinical trials of new treatments are an option as well.

Distant recurrence

Kidney cancer that recurs in distant parts of the body is treated like a stage IV cancer. Your options depend on which, if any, drugs you received before the cancer came back and how long ago you received them, as well as on your health.

For cancers that progress (continue to grow or spread) during treatment with targeted therapy or immunotherapy, another type of targeted therapy or immunotherapy may be helpful. If these don’t work, chemotherapy may be tried, especially for people with non-clear cell types of renal cell cancer. Recurrent cancers can sometimes be hard to treat, so you might also want to ask your doctor about clinical trials of newer treatments.

For some people with recurrent kidney cancer, palliative treatments such as embolization or radiation therapy may be the best option. Controlling symptoms such as pain is an important part of treatment at any stage of the disease.

For more information see Understanding Recurrence.

The treatment information given here is not official policy of the American Cancer Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Abreu SC, Finelli A, Gill IS. Management of localized renal cell carcinoma: Minimally invasive nephron-sparing treatment options. In: Vogelzang NJ, Scardino PT, Shipley WU, Debruyne FMJ, Linehan WM, eds. Comprehensive Textbook of Genitourinary Oncology. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2006:755-765.

American Cancer Society. Cancer Facts & Figures 2017. Atlanta, Ga: American Cancer Society; 2017.

Atkins MB. UpToDate. Overview of the treatment of renal cell carcinoma; This topic last updated: Jun 13, 2017. Accessed at on June 16, 2017.

Hudes G, Carducci M, Tomczak P, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. 2007;356:2271-2281.

Lane BR, Canter DJ, Rini BI, Uzzo RG. Ch 63 - Cancer of the kidney. In: DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.

Lee SI and  Shauna Duigenan S. UpToDate.  Diagnostic approach, differential diagnosis, and treatment of a small renal mass. This topic last updated: Aug 23, 2016. Accessed at on June 5, 2017. 

McDermott DF, Regan MM, Clark JI, et al. Randomized phase III trial of high dose interleukin-2 versus subcutaneous interleukin-2 and interferon in patients with metastatic renal cell carcinoma. J Clin Oncol. 2005;23:133-141.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. V.2.2017. Accessed at: on June 5, 2017.

Pili R, Kauffman E, Rodriguez R. Ch 82 - Cancer of the kidney. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier: 2014.

Richie JP. UpToDate. Definitive surgical management of renal cell carcinoma. This topic last updated: March 14, 2017. Accessed at on June 5, 2017.

Rini BI, Escudier B, Tomczak P, et al. Comparative effectiveness of axitinib versus sorafenib in advanced renal cell carcinoma (AXIS): A randomised phase 3 trial. Lancet. 2011;378:1931-1919.

Last Medical Review: August 1, 2017 Last Revised: April 30, 2019

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.