What happens after kidney cancer treatment ends and the scans come back clear? For many people living with kidney cancer, that’s when a new kind of worry begins: the fear that the cancer might return. Understanding recurrence — when cancer comes back after treatment — can help ease the anxiety or uncertainty of life after treatment.

In this article, we’ll explain how often kidney cancer comes back, what factors affect your chances, and how recurrence might influence your overall prognosis (outlook). We’ll also share practical advice on steps you can take to lower the chances of recurrence and what to expect if it does happen.

What Is Kidney Cancer Recurrence?

If treatment for kidney cancer is successful and no signs of cancer are found, you’re considered to be in remission. However, your cancer care team will still schedule regular follow-up visits. These checkups may include blood and imaging tests like CT scans. During these visits, your care team will look for any signs that the cancer has returned. If no cancer is found, you’re considered to still be in remission.

However, even if surgery or other treatments were successful, there’s still a chance the cancer could return. This is known as recurrent kidney cancer. It means the cancer has come back after a period when no signs of disease were found.

Recurrent kidney cancer may appear in the same place as before, such as in the remaining kidney tissue or the other kidney. It can also appear somewhere new, like the lungs, bones, or other organs. When kidney cancer metastasizes (spreads) to other parts of the body, it’s called metastatic kidney cancer.

How Often Does Kidney Cancer Come Back?

How likely the cancer is to return varies widely. It depends largely on the stage at which kidney cancer was first diagnosed. Staging helps doctors understand how much cancer is in the body and how far it has spread. Kidney cancer has four stages, with a higher number indicating a more advanced stage. These stages are often written in Roman numerals — for example, stage III instead of stage 3.

In general, the risk of recurrence increases with later cancer stages. The recurrence rates for kidney cancer are as follows:

• Stage 1 — About 5 percent to 7 percent
• Stage 2 — About 26 percent
• Stage 3 — About 30 percent to 50 percent
• Stage 4 — About 70 percent

It’s important to keep in mind that these numbers are just averages from large groups of people. Your personal risk of recurrence may vary depending on factors such as:

• The exact tumor size and location
• How well the cancer responded to treatment
• Your overall health

If you still have questions about what these numbers mean, talk to your healthcare team.

When Does Kidney Cancer Return?

Keep in mind that not everyone who treats kidney cancer has a recurrence. Among those who do experience recurrence, most recurrences happen within the first two to three years after surgery. That’s why follow-up care is so essential. Your doctor may schedule checkups every few months early on, depending on your personal risk.

However, some people who eventually have a recurrence may stay in remission for years before the cancer comes back. For some, the cancer may return after five years, 10 years, or even longer. This is called late recurrence.

Late recurrence isn’t as common, but it’s still possible. Studies show that up to 10 percent of people with localized (early-stage) RCC experience a recurrence after five years or more.

Factors That Raise the Risk for Recurrence

Some people have a higher chance of kidney cancer returning after treatment. Doctors can’t predict what will happen to any one individual, but studies have identified certain risk factors that can help guide predictions.

Tumor Stage, Grade, and Size

One of the biggest predictors for figuring out whether kidney cancer will return is the stage. People with stage 3 or 4 disease are at greater risk because the cancer was already more advanced when it was found.

Another key factor is the tumor grade. This describes how abnormal the cancer cells look under a microscope compared to healthy cells. High-grade tumors tend to grow and spread faster, which increases the chances of recurrence.

Tumor size also plays a role. Larger tumors are linked to an increased risk of recurrence, especially if they were more than 7 centimeters wide at the time of diagnosis.

Tumor Subtype and Specific Features

The specific subtype or features of your kidney cancer also influence recurrence risk. For example, clear cell renal cell carcinoma tends to carry a slightly higher recurrence risk than other subtypes, such as papillary RCC or chromophobe RCC.

Some tumors also have features that make them more aggressive, such as sarcomatoid differentiation or tumor necrosis. In sarcomatoid RCC, some of the cancer cells start to look more like a sarcoma, a different kind of cancer. Sarcomatoid features can mean the cancer is more likely to spread and possibly return after treatment.

Tumor necrosis is when part of the cancer cells inside the tumor start to die and break down. It may be a sign that the tumor is more aggressive, more active, or more likely to return. Both tumor necrosis and sarcomatoid differentiation can appear in any RCC subtype, including clear cell, papillary, or chromophobe.

What Happens if Kidney Cancer Comes Back?

If your kidney cancer comes back, your doctor will order tests to find out where it is and how much it has spread. In some cases, the cancer may come back in one spot, like in a different part of the urinary tract or the lungs.

If the tumor is small and hasn’t spread far, surgery may still be an option to remove it. This is more likely when the recurrence is local. Whether surgery is recommended may also depend on your overall health and ability to undergo another procedure.

When surgery isn’t possible or if the cancer has spread to other parts of the body, your doctor may recommend targeted therapy, immunotherapy, or a combination of both. Targeted therapy drugs block signals cancer cells need to grow and divide. Immunotherapy helps your immune system better recognize and attack cancer cells. The type of immunotherapy you receive depends on the specific characteristics of your tumor.

Prognosis for Kidney Cancer Recurrence

The outlook for people with recurrent kidney cancer can vary widely. Some recurrences are caught early and treated successfully, especially if the cancer is limited to one area. Others may be harder to treat if the cancer has spread to distant parts of the body, like the lungs, bones, or brain.

Your overall prognosis depends on factors such as:

• How soon after surgery the cancer came back
• How far the cancer has spread
• How well it responds to treatment
• Your overall health
• The tumor’s type and grade

People with clear cell RCC, for example, often respond better to immunotherapy than those with other subtypes.

Even in advanced cases, new treatments or new treatment combinations may help people live longer and with a better quality of life than in the past. For questions about your outlook, talk to your healthcare team. They know you best and can give you the best estimate for your specific situation.

How To Lower Your Risk of Recurrence

While there’s no way to guarantee that kidney cancer won’t return, there are steps you can take to reduce your risk. The most important step is to stick to your follow-up schedule. Go to every appointment and get all recommended imaging tests. These are crucial for catching problems early.

Follow your treatment plan exactly as prescribed. If your doctor recommends adjuvant therapy (additional treatment after surgery), complete the full course. If you smoke, try to quit. Smoking is linked to a higher risk of recurrence, as well as an increased risk of developing another type of cancer, like lung cancer.

You can keep your kidneys healthy by:

• Staying well hydrated
• Managing blood pressure
• Limiting alcohol intake to one to two drinks per day
• Eating a balanced diet
• Getting regular exercise
• Maintaining a healthy weight

Most importantly, speak up if you notice any new or unusual symptoms. Maintaining frequent communication with your healthcare team can help you stay ahead of recurrence or catch it early if it does happen. If you need extra support, reach out to trusted friends or family or seek out support groups for people living with kidney cancer. You’re not alone on this journey.

Talk With Others Who Understand

On MyKidneyCancerTeam, people with kidney cancer and their loved ones come together to ask questions, give advice, and share their stories with others who understand life with kidney disease.

Has your kidney cancer returned after treatment? What treatments have worked best for you? Share your story in the comments below, or start a conversation by posting on your Activities page.