Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team.

Treatment for kidney cancer depends on:

• the stage of the disease
• the location of the cancer
• the severity of symptoms
• your general health and wishes.

Treatment may involve the following.

Surgery

Treatment for kidney cancer often involves surgery.

As well as removing the cancer, surgery may remove:

• some of the surrounding kidney tissue – this is a partial nephrectomy
• the whole kidney – this is a simple nephrectomy
• the kidney, the adrenal gland that is located on top of the kidney and fatty tissue around the kidney, and sometimes some of the nearby lymph nodes – this is a radical nephrectomy.

The surgery may involve a single large incision in the abdomen or the back, or a number of small ones (laparoscopic surgery).

Because it allows some of the function in the kidney to be retained, a partial nephrectomy might be preferred to removal of the whole kidney if the tumour is small and single, and is in a suitable location on the kidney. However, even if a whole kidney is removed, the remaining kidney usually provides enough function to enable a person to lead a normal, healthy life. If too much kidney tissue is removed, dialysis or a kidney transplant will be needed.

Nearby lymph nodes may also be removed during surgery, especially if they are enlarged.

If the cancer has spread to other parts of the body, surgery may be used to remove the metastases, either to attempt to cure the cancer (if there is only a small number of metastases that can be removed easily) or to relieve pain and other symptoms.

Side effects of surgery for kidney cancer might include pain after the operation, leakage of urine into the abdomen (after partial nephrectomy) or kidney failure (if the remaining kidney does not function well).

Ablation

Removal of tissue (ablation) by means other than surgery is sometimes used to attempt to destroy kidney tumours. Types of ablation include:

• cryotherapy – use of extreme cold (delivered at the end of a needle probe)
• radiofrequency ablation – use of high-energy radio waves to heat the tumour (delivered via a needle probe)
• arterial embolisation – blocking the artery that feeds the affected kidney, to starve the tumour of oxygen and nutrients, causing it to shrink.

Active surveillance

If the kidney tumour is small, doctors may decide to keep a watch on the tumour to see whether it grows. This approach is most likely to be used in elderly or frail people, to avoid the risks associated with surgery.

Chemotherapy

Chemotherapy is not generally used for kidney cancer because kidney cancer cells do not usually respond to traditional chemotherapy medicines.

Radiotherapy

Along with surgery, some people may receive radiotherapy. This is usually done if there is a suspicion that some cancer cells are left behind.

Some kidney cancers do not respond well to radiation, so radiotherapy by itself is more likely to be used in people who need to avoid the risks of surgery. It can also be used to ease the symptoms of kidney cancer. Newer types of radiation treatment might lead to better outcomes in the future.

Targeted therapy

Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells.

Targeted medicines are often used to treat advanced kidney cancers. Although they can shrink or slow the growth of the cancer, none of them have been shown to cure it.

Medicines used for targeted therapy of kidney cancer include sunitinib, pazopanib, temsirolimus, everolimus, sorafenib, bevacizumab and axitinib. These medicines either prevent the formation of new blood vessels (angiogenesis) that are needed for the cancer to grow and spread, or block proteins in cancer cells that help them grow and survive.

Follow-up

After treatment, you will need regular follow-up checks to look for signs that the cancer has recurred or side effects of the treatment. These might include physical examinations, blood tests and CT scans.

Advanced and recurrent cancer

If you are diagnosed with stage IV kidney cancer (where the cancer has spread to other parts of the body), the treatment depends on how much the cancer has spread and on your general health. Surgery can be used if it appears possible to remove the main tumour and the metastases; this would only be possible if the cancer has spread to only 1 other area of the body. However, even if the cancer has spread more extensively, surgery to remove the affected kidney might still be helpful.

If surgery is not possible, targeted therapy is likely to be used.

Palliative treatments for advanced kidney cancer – that is, treatments that aim to relieve symptoms such as pain – include radiotherapy and embolisation.

Kidney cancer can recur (come back) after treatment. The cancer can recur in the kidney or somewhere else in the body, and is classified as local or distant (often called metastatic cancer).

Treatment for recurrent kidney cancer depends on where it occurs, the treatments that have been used previously and your general health. Options are further surgery, targeted therapy, chemotherapy and palliative treatments.