Treatment Options
Treatments for renal cell carcinoma (RCC) include:
*For kidney masses other than RCC, visit the Diagnosis and Stages page to find more information about treatment.
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Surgery
Surgery may be the first step in treating your kidney cancer. It may be the only treatment you need, or part of a larger treatment plan.
Kidney cancer surgery, called a nephrectomy, has 2 types:
- Partial nephrectomy – removes just the part of the kidney that contains the tumor and some of the tissue around it.
- Radical nephrectomy – removes the whole kidney and often the adrenal gland above the kidney, the tissue around it, and the lymph nodes next to the kidney. Most people do fine living with the 1 remaining kidney, but close monitoring may be needed.
There are 2 ways a nephrectomy can be done:
- Open surgery – the surgeon makes 1 cut in the middle of your belly, under your ribs, or in your back.
- Laparoscopic surgery – the surgeon removes parts or the whole kidney through several small cuts instead of 1 large cut. They use a long tube with a small video camera at the end (called a laparoscope) to let them see inside your body. It is also called minimally invasive surgery.
The type of surgery you get depends on the tumor type, size, location, how much the cancer has spread to other organs, and your physical condition. Even if the cancer has spread, surgery may still be helpful because it removes some of the cancer. With some of the cancer gone, other treatments may work better.
Watch presentations from experts to learn more:
*Surgical and pathology images included in the presentations
Systemic treatments
Systemic treatments are medicines that treat the entire body to kill cancer cells. They travel through the bloodstream to treat cancer cells wherever they are in the body.
They may be given as pills or as liquids given through a vein (called IV or intravenous). Systemic treatments treat kidney cancer that:
- Is stage 4
- Has recurred (come back after previous treatment)
They can also be given:
- Before surgery to help shrink the tumor (called neoadjuvant therapy)
- After surgery to help lower the chance of recurrence, if it is highly likely the cancer may return (called adjuvant therapy)
The 2 main types of systemic treatments for kidney cancer are:
- Targeted therapies
- Immunotherapies
Systemic treatments are only approved after clinical trials confirm they are safe and work well in patients with kidney cancer. In the United States, the Food & Drug Administration (FDA) approves cancer treatments.
Targeted therapy
Targeted therapies are medicines that target specific molecules (such as proteins) on or in cancer cells. These molecules control how cancer cells grow, divide, and spread. This is different from chemotherapy, which often kills all cells that grow and divide quickly, not just cancer cells.
Most of the targeted therapies that treat kidney cancer work by either:
- Blocking the process of how new blood vessels grow and feed the cancer
- Blocking certain proteins in cancer cells that help them grow
Sometimes, a combination of targeted therapies may be recommended:
Immunotherapy
Immunotherapies are a type of drug that boosts a person’s immune system (the body’s natural defense against disease) to find and destroy cancer cells.
The main type of immunotherapy for kidney cancer are checkpoint inhibitors.
Checkpoint inhibitors
Our immune system fights against disease yet can keep itself from attacking healthy cells in our body. We have checkpoint proteins that act as “brakes” on some immune system cells (called T-cells) to make sure our immune system only attacks bacteria and viruses, and not the body itself. Cancer cells sometimes use these proteins to avoid getting attacked by T cells to survive in the body and to help the cancer cells grow.
Checkpoint inhibitor medicines stop (or inhibit) these protein molecules, which lets the immune system release more T cells to attack and kill the cancer cells.
Ipilimumab (Yervoy®)
Often one checkpoint inhibitor is used in combination with another checkpoint inhibitor or targeted therapy. These combinations include:
Cytokines
Cytokines are small proteins that can boost the immune system. Doctors don’t use them very often today because there are newer medicine options. They may be used to treat kidney cancer in very specific cases.
Watch presentations from experts to learn more:
Radiation therapy
Radiation therapy uses high-energy waves (such as X-rays) to destroy or damage cancer cells. It works by damaging the DNA inside the cancer cell. This damage keeps cells from growing and multiplying.
Radiation therapy may be used to:
- Treat kidney cancer if you’re not healthy enough for surgery
- Manage and control pain if the cancer has spread to your bones, spine, or brain
External beam radiotherapy (EBRT)
The type of radiation therapy most often used for kidney cancer is external beam radiotherapy (EBRT). EBRT uses a machine to aim the high-energy waves at the cancer from outside your body. The machine focuses the radiation beam on the exact location of your cancer. It reaches as many cancer cells as possible, while limiting damage to healthy cells. A special type of EBRT that may be used is stereotactic body radiotherapy (SBRT).
Radiation is given over multiple treatments, once a day, at an outpatient radiation treatment center. The number of treatments you’ll have depends on:
- The type of kidney cancer you have
- Where in your body the radiation therapy will be directed
- The goal of your treatment
- The amount of radiation you get each time
Watch presentations from experts to learn more:
Ablation therapy
When patients choose not to have surgery, or they’re too sick for surgery, they can choose less invasive treatments like ablation.
Ablation therapy options include:
- Cryotherapy or cryoablation – a needle delivers extremely cold gasses right at a tumor to destroy it.
- Radiofrequency ablation – radio waves are delivered through a probe at the tumor, and an electric current destroys the cancer cells.
Watch presentations from experts to learn more:
Observation or active surveillance
(watch and wait)
Observation or active surveillance is when you do not get any treatment for cancer. Instead, you and your care team closely watch and check your cancer with imaging tests such as CTs, MRIs, or ultrasounds.
Your care team will plan a regular testing schedule for you and will look for any changes in the growth of your tumor or new tumors that may mean the cancer has returned. You may then start treatment if they find any changes.
Observation or active surveillance may only be used for certain people, such as:
- Those with very small, stage 1 tumors that haven’t spread beyond the kidney
- Those with advanced kidney cancer that don’t need systemic treatment yet
- Older people or those with other health conditions who may not tolerate treatment. For some people, the risks of cancer treatment side effects may be more dangerous than the cancer itself.
Watch presentations from experts to learn more:
Supportive care
Supportive care, sometimes called palliative care, can help you and your family deal with the challenges of kidney cancer. It’s not the same as hospice care, which is end-of-life care.
It can help relieve symptoms and improve your quality of life. Supportive care specialists consider your physical, social, and spiritual needs when designing a treatment.
They can help you:
- Manage side effects, such as nausea, pain, fatigue, or lower appetite
- Focus on family and work life
- Eat healthy and stay active
- Deal with practical matters such as health insurance or treatment coverage
- Cope with the emotional stress of your cancer diagnosis
You can get supportive care along with kidney cancer treatments. While supportive care can transition into hospice care if needed, it’s useful at any time during your cancer journey.
Supportive care is recommended for all people living with kidney cancer. Many oncology departments have supportive or palliative care specialists on staff, such as doctors, nurses, pharmacists, social workers, psychologists, religious leaders, or other healthcare professionals to work with you and your family.
Treatment options by stage
Your treatment options may change depending on the stage of your cancer. Your cancer care team will discuss your options together to help you make this important decision together.
Stages 1 and 2 (I and II)
- Surgery
- Partial nephrectomy
- Radical nephrectomy
- Radiation therapy
- Ablation therapy
- Active surveillance
- Systemic treatment
- Immunotherapy after surgery to prevent the cancer from coming back
Stage 3 (III)
- Surgery
- Radical nephrectomy
- Partial nephrectomy may be done in certain cases
- Systemic treatment
- Immunotherapy after surgery to prevent the cancer from coming back
- Radiation therapy
Stage 4 (IV)
- Systemic treatment
- Targeted therapies
- Immunotherapies
- Radiation therapy
- Surgery
- Radical nephrectomy in certain cases
*Clinical trials that use any of these options may be recommended
*Supportive care can be used with any option
References:
Information on this page last reviewed: January, 2025
Keep Learning:
The Kidney Cancer Association provides educational literature for anyone impacted by kidney cancer.