Treatment of Kidney Cancer, by Type and Stage

The treatment your cancer care team recommends will depend mainly on the type and stage of your kidney cancer, as well as your overall health and personal preferences. Other factors might also affect your treatment options.

Clear cell renal cell carcinoma

Clear cell renal cell carcinoma (RCC) is the most common type of kidney cancer in adults.

Stage I

Active surveillance 

Small, stage I cancer does not always need to be treated right away. In some cases, these tumors might be watched carefully with imaging tests early on, to see if they grow or change. If the tumors stay the same over time, they might never cause any serious problems. This approach is called active surveillance.

Treatment 

In other cases, these tumors might need treatment. Surgery to remove part or all of the kidney where the tumor grew is most commonly recommended. In some cases where surgery is not a good option, radiation or an ablation procedure might be considered.

Stages II and III

Stage II and III clear cell RCC should be treated.

• Surgery: Treatment often includes surgery to remove part or all of the kidney where the tumor grew. In some cases, surgery is the only recommended treatment.
• Other treatments: Depending on a number of factors, your care team might recommend additional treatment with immunotherapy, targeted therapy, or a combination.
• Radiation: If surgery is not an option, radiation might be considered.

After treatment, the care team will watch closely with tests to make sure the cancer has not come back.

Stage IV

Treatment of stage IV kidney tumors depends on how far and how much the cancer has spread.

If the cancer can be removed with surgery

If a stage IV cancer can be removed completely with surgery, the recommendation is to remove the kidney where the tumor grew and any sites of spread, when possible.

In some cases, surgery is the only recommended treatment, followed by close monitoring for signs of recurrence. Depending on a number of factors, your care team might recommend additional immunotherapy treatment, with or without targeted therapy.

It the cancer cannot be removed completely with surgery

If a stage IV cancer cannot be removed completely, doctors still sometimes recommend surgery to remove as much cancer as possible.

These surgeries are called:

• Cytoreductive nephrectomy (when the kidney is removed)
• Metastatectomy (when areas of spread are removed)

They can be done before or after other treatments, if the tumors respond well to therapy. Certain areas of spread might be treated with ablation procedures or radiation as well.

For stage IV cancers that cannot be removed completely with surgery, targeted therapy with or without immunotherapy is often recommended. If one treatment doesn’t work, or stops working, another one can often be tried. Clinical trials might also provide other treatment options or newer therapies.

Other kidney cancers

This includes papillary RCC, chromophobe RCC, renal medullary carcinoma, and collecting duct carcinoma.

Stage I

Active surveillance

Small, stage I cancer does not always need to be treated right away. In some cases, these tumors might be watched carefully with imaging tests early on, to see if they grow or change. If the tumors stay the same over time, they might never cause any serious problems. This approach is called active surveillance.

Treatment

In other cases, these tumors might need treatment. Surgery to remove part or all of the kidney where the tumor grew is most commonly recommended. In some cases where surgery is not a good option, radiation or an ablation procedure might be considered.

Stages II and III

Stage II and III non-clear cell RCC should be treated.

Treatment usually includes surgery to remove part or all of the kidney where the tumor grew. In some cases where surgery is not an option, radiation might be considered.

After surgery to remove the tumor, the care team will watch closely with tests to make sure the cancer has not come back. Clinical trials should be considered, if available.

Stage IV

Treatment of stage IV kidney tumors depends on how far and how much the cancer has spread.

Stage IV cancers that can be removed with surgery

For stage IV cancers that can be removed completely with surgery, the recommendation is to remove the kidney where the tumor grew and any sites of spread, when possible.

Stage IV cancers that cannot be removed completely with surgery

If the cancer cannot be removed entirely, surgery to remove as much as possible is sometimes still recommended.

These procedures are called:

• Cytoreductive nephrectomy (when the kidney is removed)
• Metastatectomy (when areas of spread are removed)

They can be done before or after other treatments, if the tumors respond well to therapy. Certain areas of spread might be treated with ablation procedures or radiation as well.

Treatment with targeted therapy, immunotherapy, or a combination is most often recommended. Your care team might recommend a specific treatment based on the type of non-clear cell RCC you have. If one treatment doesn’t work, or stops working, another one can often be tried.

In the case of collecting duct carcinoma and renal medullary carcinoma, chemotherapy might be recommended for treatment.

Clinical trials might also provide other treatment options or newer therapies.

Recurrent kidney cancer

When kidney cancer comes back after initial treatment, it is considered recurrent. This can be:

• Local recurrence, near the area of the original tumor
• Distant recurrence, in distant parts of the body

If this happens, your treatment will depend on where the cancer recurs and what treatments you’ve already had. It will also depend on your health and wishes for further treatment.

Treating local recurrence

For cancers that recur after surgery and near the area of the original kidney tumor, treatment options might include further surgery or other localized treatments, or radiation.  

Even if not all of the cancer can be removed or destroyed, these treatments might still help relieve symptoms in some people.

Other treatment options will most likely include immunotherapy and/or targeted therapy drugs. Clinical trials of new treatments are an option as well.

Treating distant recurrence

Kidney cancer that recurs in distant parts of the body is treated like stage IV cancer (see above).

Your options will depend on:

• The location of the cancer
• Whether or not it is thought to be removable
• Which drugs you received as part of your first treatment, if any
• How long ago you got those drugs
• Your overall health and hidden preferences

For cancers that continue to grow or spread during treatment with immunotherapy or targeted therapy drugs, different drugs might still be helpful.

Recurrent cancers can sometimes be hard to treat, so you might also want to ask your doctor about clinical trials.

Palliative care

Palliative treatments may be the best option for some people with recurrent kidney cancer. These treatments are intended to help control the cancer and relieve any symptoms it causes.

Palliative options might include radiation therapy, ablative treatments, or even some type of surgery, if you are healthy enough. Controlling symptoms such as pain is also an important part of treatment at any stage of the disease.

For more information, see Understanding Recurrence.