The type of treatment(s) your doctor recommends will depend on the stage of the cancer and on your overall health. This section sums up the options usually considered for each stage of kidney cancer.
Stages I, II, or III
Stage I and II cancers are still contained within the kidney. Stage III cancers have either grown into nearby large veins or have spread to nearby lymph nodes.
These cancers are usually removed with surgery when possible. Either a partial nephrectomy (removing part of the kidney) or a radical nephrectomy (removing the entire kidney) may be done. Partial nephrectomy is often the treatment of choice in tumors up to 7 cm (a little less than 3 inches in size) if it can be done. The lymph nodes near the kidney may be removed as well, especially if they are enlarged.
If the cancer has grown into nearby veins (as with some stage III cancers), the surgeon may need to cut open these veins to remove all of the cancer. This may require putting you on bypass (a heart-lung machine), so that the heart can be stopped for a short time to remove the cancer from the large vein leading to the heart.
So far, giving other treatments after surgery (known as adjuvant therapy) such as targeted therapy, chemotherapy,radiation therapy, or immunotherapy has not been shown to help patients live longer if all of the cancer has been removed. There are, however, ongoing clinical trials that are looking at adjuvant treatment for kidney cancer. Ask your doctor if you are interested in learning more about adjuvant therapies being studied in clinical trials.
If you cannot have kidney surgery because of other serious medical problems, you may benefit from other local treatments such as cryotherapy, radiofrequency ablation, or arterial embolization. Radiation therapy may be another option. These treatments are generally only given when surgery can’t be done. Although they haven’t been compared to surgery directly in studies, most doctors consider these treatments to be less effective than surgery.
Active surveillance is another option for some people with small kidney tumors. In this approach, the tumor is watched closely (with CTs or ultrasounds) and only treated if it grows.
Stage IV kidney cancer means that the cancer has grown outside of the kidney or it has spread to other parts of the body such as distant lymph nodes or other organs.
Treatment of stage IV kidney cancer depends on how extensive the cancer is and on the person’s general health. In some cases, surgery may still be a part of treatment.
In rare cases where the main tumor appears to be removable and the cancer has only spread to one other area (such as to one or a few spots in the lungs), surgery to remove both the kidney and the metastasis may be an option if a person is in good enough health. Otherwise, treatment with one of the targeted therapies would probably be the first option.
If the main tumor is removable but the cancer has spread extensively elsewhere, removing the kidney may still be helpful. This would likely be followed by systemic therapy, which might consist of one of the targeted therapies orimmunotherapy (interleukin-2). More often targeted therapy is used first. It’s not clear if any one of the targeted therapies or any particular sequence is better than another, although temsirolimus appears to be most useful in people with kidney cancers that have a poorer prognosis (outlook).
For cancers that can’t be removed surgically (because of the extent of the tumor or a person’s health), first-line treatment is likely to be one of the targeted therapies or cytokine therapy.
Because advanced kidney cancer is very hard to cure, clinical trials of new combinations of targeted therapies, immunotherapy, or other new treatments are also options.
For some patients, palliative treatments such as embolization or radiation therapy may be the best option. A special form of radiation therapy called stereotactic radiosurgery can be very effective in treating single brain metastases. Surgery or radiation therapy can also be used to help reduce pain or other symptoms of metastases in some other places, such as the bones. You can read more about palliative treatment for cancer in the Palliative Care section of our website or in Advanced Cancer.
Having your pain controlled can help you maintain your quality of life. It’s important to realize that medicines to relieve pain do not interfere with your other treatments and that controlling pain will often help you be more active and continue your daily activities.
Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Treatment of kidney cancer that comes back (recurs) after initial treatment depends on where it recurs and what treatments have been used, as well as a person’s health and wishes for further treatment.
For cancers that recur after initial surgery, further surgery might be an option. Otherwise, treatment with targeted therapies or immunotherapy will probably be recommended. Clinical trials of new treatments are an option as well.
For cancers that progress (continue to grow or spread) during treatment with targeted therapy or cytokine therapy, another type of targeted therapy or immunotherapy may be helpful. If these don’t work, chemotherapy may be tried, especially in people with non-clear cell types of renal cell cancer. Clinical trials may be a good option in this situation for those who want to continue treatment.
Again, for some patients, palliative treatments such as embolization or radiation therapy may be the best option. Controlling symptoms such as pain is an important part of treatment at any stage of the disease.