Treatment of Kidney Cancer by Stage

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 in the kidney. Stage III cancers either have 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. Another option for people who have had surgery but are at a higher risk of the cancer coming back, is one year of the immunotherapy drug pembrolizumab. Treatment given after surgery is known as adjuvant therapy.   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 can't have kidney surgery because of other serious medical problems, you might benefit from other local treatments such as cryotherapy or radiofrequency ablation. 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 outcomes similar 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.

Some stage III cancers cannot be completely removed by surgery or treated with radiation. In these cases, the cancers might be treated with targeted therapy drugs alone or in combination with immunotherapy.  

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. In certain cases, removing the area of spread can help people live longer. For some people who have the main tumor removed along with a few areas of distant cancer spread, adjuvant treatment with the immunotherapy drug pembrolizumab for one year, might be considered. Radiation, instead of surgery, might also be an option to treat the area of cancer spread.

If the main tumor is still there, and the cancer has spread extensively elsewhere, removing the tumor in the kidney is not recommended in most cases, as it had been in the past. This is based on recent information that shows removal of the kidney in this case does not help people live longer. The first treatment choice would be systemic therapy, which might consist of two immunotherapy drugs, a targeted therapy drug with an immunotherapy drug, or a targeted therapy drug alone. It’s not clear if any one of these therapies or any particular sequence is better than another, although the combinations of ipilimumab along with nivolumab, axitinib with pembrolizumab, and cabozantinib with nivolumab appears to be most helpful for people with advanced kidney cancer.

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 radiation therapy may be the best option. A special form of radiation therapy called stereotactic radiosurgery can be very effective in treating 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. If surgery cannot remove the area of recurrence, treatment with two immunotherapy drugs, a combination of an immunotherapy drug plus a targeted therapy drug, or in some cases, a targeted therapy drug alone may 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. Recurrent cancers can sometimes be hard to treat, so you might also want to ask your doctor about clinical trials.

For some people with recurrent kidney cancer, palliative treatments such as 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.