Kidney cancer is often treated by a team that includes a urologist (urinary tract specialist), a nephrologist (kidney specialist), and an oncologist (cancer specialist). Your cancer care team will consider several factors when suggesting a treatment plan for you, including:

• Your cancer stage, grade, and other details about your tumor
• Your cancer’s spread status
• Your goals for treatment (to cure cancer if possible, or to extend life, achieve comfort, and relieve symptoms)
• Your age and overall health
• Your personal preferences

This article will help you understand the basics about kidney cancer treatment options so you can have better conversations with your care team about treatment decisions.

1. Surgery

Surgery to remove all or part of the affected kidney is the preferred treatment option for people with kidney cancer that hasn’t spread to other parts of the body. Surgery may also be helpful for people who have cancer that has metastasized (spread to other organs). In most cases, people can live well with just one kidney.

The surgeon will consider the size and location of the kidney tumor before recommending the best type of surgery. The following types of surgery may be used in the treatment of kidney cancer:

• Partial nephrectomy — Surgery to remove the part of the kidney affected by the tumor
• Simple nephrectomy — Surgery to remove the kidney only
• Radical nephrectomy — Surgery to remove the kidney and surrounding tissues, including the adrenal gland and nearby lymph nodes

Surgery for kidney cancer may be done using open or laparoscopic techniques. In open surgery, the surgeon will make one longer cut in the abdomen. In laparoscopic surgery, the surgeon will make several smaller cuts and use specialized tools or a robot to remove the kidney. This has the advantage of a quicker recovery and fewer possible complications.

People with stage 1 or stage 2 kidney cancer may not need any additional treatment after surgery. The cancer cells removed during surgery will be analyzed in a laboratory for signs that the cancer may spread or recur (come back). If your healthcare team finds any troubling signs, they may recommend additional treatment to reduce the risk of recurrence. Treatment given after initial therapy, usually surgery, is known as adjuvant treatment.

2. Ablation or Embolization

Local treatments such as ablation or arterial embolization can be used when surgery isn’t a good treatment option. Ablation refers to the destruction of tissue with heat, cold, or energy. There are several different types of ablation therapy, discussed below.

Cryoablation

Cryoablation (also called cryotherapy) uses extreme cold to destroy cancer cells. During this treatment, cold gases are passed into the tumor through a hollow needle. The gases form a ball of ice at the tip of the needle that destroys cancer cells.

Radiofrequency Ablation

Radiofrequency ablation (RFA) uses extreme heat to destroy cancer cells. In this procedure, a surgeon will insert a probe through the skin until the probe tip is touching the tumor. When the probe is in the proper place, an electric current is sent down the probe to heat the tumor and destroy cancer cells.

Other Types of Ablation Therapy

Cryoablation and RFA have been used the longest to treat kidney cancer. Newer ablative treatments aren’t as well researched but may be helpful for some people with kidney cancer. Other types of ablation therapy include:

• Microwave ablation — A technique that uses electromagnetic waves to destroy cancer cells
• Stereotactic body radiation therapy (SBRT) — A type of radiation therapy that uses thin beams of radiation to destroy cancer cells
• Irreversible electroporation — A technique that uses an electrical field to create holes in the cancer cells, leading to their death

Arterial Embolization

Arterial embolization is a procedure to block the blood supply to the affected kidney or kidney tumor. This procedure is done by inserting a long, thin tube into the artery that supplies oxygen-rich blood to the kidney. A gelatin sponge is injected into the artery to block the blood flow. Without a fresh supply of blood, the kidney tumor may shrink or grow more slowly.

3. Radiation Therapy

Radiation therapy uses high-energy X-rays or other particles to kill cancer cells. When radiation therapy is used for kidney cancer, it’s typically given as external beam radiation therapy (EBRT). This method uses a machine outside the body to aim precise beams of radiation directly at the tumor.

Most people with kidney cancer don’t get radiation therapy as their primary treatment. The cancer care team may recommend radiation therapy for some people with advanced kidney cancer who:

• Can’t have or don’t want surgery
• Have a kidney tumor on their only working kidney
• Want to relieve symptoms and improve quality of life in advanced kidney cancer (palliative radiation therapy)
• Have kidney cancer that’s spread to other parts of the body

4. Immunotherapy

Immunotherapy uses a person’s own immune system to kill cancer cells. Your doctor may recommend immunotherapy drugs as your main treatment if you have advanced kidney cancer. If you have had surgery to remove a kidney tumor but laboratory tests find the cancer has a high risk of returning, your doctor may recommend that you take an immunotherapy drug as adjuvant therapy.

Immunotherapy drugs for kidney cancer target part of the immune system called immune checkpoints. Immune checkpoint proteins normally prevent the immune system from attacking healthy cells. In some cases, kidney cancer cells use immune checkpoints to avoid detection by the immune system. Immune checkpoint inhibitors help the immune system find cancer cells by blocking these checkpoint proteins. Examples of immune checkpoint inhibitors used to treat kidney cancer include:

• Avelumab (Bavencio)
• Ipilimumab (Yervoy)
• Nivolumab (Opdivo)
• Pembrolizumab (Keytruda)

Immunotherapy drugs for kidney cancer are given as an intravenous (IV) infusion into the bloodstream every two to six weeks, depending on the drug type.

Pembrolizumab is often recommended as an adjuvant treatment after surgery for people with a high risk of kidney cancer recurrence. Most people will keep taking pembrolizumab for about one year after surgery.

5. Targeted Therapy

Targeted therapies are drugs that target molecular differences between cancer cells and healthy cells. Targeted therapy drugs are most often used to treat advanced kidney cancer, but they may be helpful as an adjuvant therapy to lower the risk of recurrence after surgery.

Several different targeted therapy drugs can be used to treat kidney cancer, including:

• Axitinib (Inlyta)
• Belzutifan (Welireg)
• Bevacizumab (Avastin)
• Cabozantinib (Cabometyx)
• Everolimus (Afinitor)
• Lenvatinib (Lenvima)
• Pazopanib (Votrient)
• Sunitinib (Sutent)
• Temsirolimus (Torisel)
• Tivozanib (Fotivda)

Your cancer care team may recommend biomarker testing to see which targeted drugs may work best. If one treatment doesn’t work well, you may be able to try another one.

Many targeted therapy drugs are given as a pill taken by mouth, although some are given as an IV infusion.

6. Chemotherapy

The most common type of kidney cancer, clear cell renal cell carcinoma, typically doesn’t respond well to chemotherapy (chemo). Therefore, many people with renal cell carcinoma don’t have chemotherapy as part of their treatment plan.

Chemotherapy may be helpful for some rare types of kidney cancer, such as collecting duct renal cell carcinoma or renal medullary carcinoma. Chemo is given as an IV infusion.

7. Active Surveillance

Active surveillance involves watchful waiting but no active treatment. This approach may be recommended for people who have small kidney tumors and are older or aren’t healthy enough for surgery or ablation.

People who choose active surveillance will return to their healthcare provider for regular blood tests and imaging scans. The cancer care team may also recommend a kidney biopsy — a procedure to remove a small amount of kidney tissue. Examining the kidney tissue under a microscope can give more information about what kind of treatment, if any, is needed.

8. Clinical Trials

Kidney cancer clinical trials have helped find new treatments and new combinations of treatments. Your cancer care team may recommend joining a clinical trial if you have advanced or recurrent kidney cancer. Being part of a clinical trial may give you access to new treatments that aren’t available yet. When you participate in a clinical trial, you’re also helping to advance cancer research. Talk to your cancer care team to see if you qualify for a clinical trial in your area.

You can also use the National Cancer Institute’s clinical trial search tool to find clinical trials currently accepting new participants.

Find Your Team

On MyKidneyCancerTeam, the social network for people living with kidney cancer and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with kidney cancer.

What treatment have you used for kidney cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.