Understanding Kidney Cancer

How Is Kidney Cancer Treated?

Last updated and reviewed on June 13, 2026.

Treatment for kidney cancer depends on several things: the stage and grade of the cancer, the size and location of the tumor, your age, your overall health, and your personal preferences. Your care team will likely include specialists such as a urologist (a doctor who specializes in the urinary system), a medical oncologist (who manages cancer medicines), and sometimes a radiation oncologist (who specializes in radiation treatment). At many kidney cancer centers, these specialists work together as a multidisciplinary team to create the best possible plan for you.

Surgery

Surgery is the main treatment for most kidney cancers, especially those that have not spread beyond the kidney.

Radical Nephrectomy. This surgery removes the entire kidney, along with the surrounding fatty tissue and sometimes the adrenal gland and nearby lymph nodes. It is the standard approach for large tumors or tumors in difficult locations. Today, radical nephrectomy is often done using minimally invasive techniques (laparoscopic or robotic surgery), which means smaller incisions, less pain, and faster recovery compared to traditional open surgery.

Partial Nephrectomy (Kidney-Sparing Surgery). When the tumor is small enough (generally 4 cm or less, though sometimes larger), surgeons can remove just the tumor and a small margin of healthy tissue while leaving the rest of the kidney in place. This is called partial nephrectomy or nephron-sparing surgery. Preserving kidney function is important, especially for patients with only one kidney, reduced kidney function, or conditions that put the other kidney at risk. Partial nephrectomy is now the preferred approach for Stage I tumors whenever technically feasible.

Surgery for Metastatic Disease. In carefully selected patients with Stage IV kidney cancer, surgery may still play a role. Cytoreductive nephrectomy (removing the primary kidney tumor even when the cancer has spread) was previously standard practice and may still benefit selected patients. Resection of metastatic lesions (surgically removing tumors that have spread to the lungs, liver, or other organs) can sometimes lead to long-term remission in patients with limited metastatic disease.

Ablation Therapies (Minimally Invasive Alternatives to Surgery)

For patients who cannot safely undergo surgery, for example, due to older age, other medical conditions, or a poorly functioning remaining kidney, ablation therapies can destroy small kidney tumors without removing them.

• Radiofrequency ablation (RFA): Uses electrical current to heat and destroy tumor cells.
• Cryoablation: Uses extreme cold to freeze and destroy tumor cells.

These procedures are done through the skin using imaging guidance and are typically outpatient procedures. They are most appropriate for small tumors (under 3–4 cm) and carry a slightly higher risk of local recurrence than surgery.

Active Surveillance

For very small kidney masses (under 2–3 cm), particularly in older or less healthy patients, active surveillance (careful, regular monitoring without immediate treatment) may be recommended. Many very small kidney tumors grow slowly and may never cause problems. Active surveillance involves regular imaging every 3–6 months to watch for growth. If the tumor grows significantly, treatment can be initiated. This approach avoids the risks of surgery for tumors that may never need treatment.

Targeted Therapy

Targeted therapies are drugs that block specific proteins or pathways that cancer cells depend on to grow. They have transformed the treatment of advanced kidney cancer over the past two decades.

• VEGF/VEGFR inhibitors (anti-angiogenic drugs): Kidney tumors rely heavily on blood vessel growth (angiogenesis) to survive and grow. Drugs like sunitinib, pazopanib, sorafenib, cabozantinib, and axitinib block the signals that tumors use to grow new blood vessels, essentially starving the tumor.
• mTOR inhibitors: Drugs like everolimus and temsirolimus block the mTOR pathway, which helps cancer cells grow and survive. These are used in certain situations, especially after other treatments have stopped working.

Immunotherapy

Immunotherapy uses medicines to help your own immune system find and destroy cancer cells. It has become a cornerstone of advanced kidney cancer treatment.

• Checkpoint inhibitors: Drugs like nivolumab (Opdivo), ipilimumab (Yervoy), and pembrolizumab (Keytruda) block signals that cancer cells use to "hide" from the immune system. These drugs have dramatically improved outcomes for many patients with metastatic kidney cancer.
• Combination regimens: The most significant recent advances in kidney cancer have come from combining immunotherapy with targeted therapy or combining two immunotherapy drugs. Regimens such as nivolumab + ipilimumab, pembrolizumab + axitinib, and nivolumab + cabozantinib have become standard first-line treatments for metastatic kidney cancer and have extended survival significantly.

Radiation Therapy

Traditional radiation therapy has a limited role in treating the primary kidney tumor. However, it is commonly used for palliative purposes, meaning to relieve symptoms caused by metastases. For example, radiation can be very effective for treating painful bone metastases or brain metastases. Stereotactic body radiation therapy (SBRT) is a newer, highly targeted form of radiation that can deliver a precise, high dose to a small tumor or metastasis with minimal damage to surrounding tissue. It is increasingly used for metastatic kidney cancer lesions.

Supportive Care During Treatment

Supportive care (also called palliative care) is an important part of kidney cancer treatment at every stage. It is often misunderstood that palliative care is not the same as hospice care, and it is not about giving up. It is about helping you feel as well as possible while you are fighting cancer. Supportive care can begin at the time of diagnosis, alongside your active treatment, and continue throughout your journey.

Supportive care for kidney cancer can include:

• Medications to manage pain, nausea, fatigue, or other side effects
• Nutritional counseling to help maintain strength and a healthy weight
• Physical therapy to maintain function and manage fatigue
• Emotional and psychological support, including counseling for anxiety and depression
• Social work services to help with practical concerns like insurance, transportation, and disability
• Spiritual care for patients and families

Research has shown that patients who receive early supportive care alongside their cancer treatment report better quality of life and sometimes even better outcomes than those who receive standard oncology care alone. Ask your care team about what supportive care services are available to you.

What Is Follow-Up Care After Treatment Ends?

When your main cancer treatment ends, regular follow-up care begins. The goals of follow-up are to watch for any signs of recurrence (the cancer coming back), monitor for late side effects of treatment, and support your overall health.

Kidney cancer does recur in some patients even years after the original tumor was removed. Early detection of recurrence allows for faster treatment. Follow-up care typically includes:

• Regular imaging: CT scans of the chest, abdomen, and pelvis on a schedule determined by your doctor (often every 3–6 months for the first few years, then annually). The exact frequency depends on your tumor's stage and grade.
• Blood and urine tests: To monitor kidney function, especially if you had all or part of a kidney removed.
• Physical exams: To check overall health and detect any new symptoms.
• A survivorship care plan: A written summary of your diagnosis and treatment, along with a plan for follow-up monitoring. Ask your care team for one if you have not yet received it.

It is very important to keep copies of your own medical records and treatment summaries. Staying connected to your care team through regular follow-up gives you the peace of mind of knowing your health is being watched over and the best chance of catching any problem early.

Sources:

1. National Cancer Institute. Renal Cell Cancer Treatment (PDQ) – Patient Version. https://www.cancer.gov/types/kidney/patient/kidney-treatment-pdq
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