Renal Cell Carcinoma (Kidney Cancer): Treatment Options and the Latest Advances

Renal cell carcinoma is the most common type of kidney cancer. Most people with renal cell carcinoma find out about their cancer by accident. Since most people don’t experience symptoms, most tumors are caught when people have a CT or MRI study for another reason. 

If you’ve recently been diagnosed with renal cell carcinoma, you too may have been caught off guard when you heard the news. But as you’re processing this information, you may be wondering about your treatment options. 

Treatment for renal cell carcinoma cancer is based on the type of cancer, the size of the tumor and whether the cancer has spread outside of the kidney. Here’s a breakdown of the most common treatment options for this type of kidney cancer.

What are the stages of renal cell carcinoma?

Renal cell carcinoma is divided into stages. The stages describe:

• The size of the tumor

• If the tumor has grown outside the kidney and into nearby blood vessels or organs

• If the tumor has spread to the lymph nodes or to other organs

There are four stages and your cancer stage determines your options for treatment.

• Stage 1a: The tumor is 4 cm or smaller. It hasn’t spread outside the kidney.

• Stage 1b: The tumor is between 4 cm and 7 cm in size. It hasn’t spread outside the kidney.

• Stage 2: The tumor is larger than 7 cm. It hasn’t spread outside the kidney.

• Stage 3: The tumor is growing into a major vein or into the tissue around the kidney but hasn’t spread to the lymph nodes or other organs, or the tumor has spread to local lymph nodes but not beyond the structures around the kidney.

• Stage 4: The cancer has spread to other parts of the body. This is an advanced form of kidney cancer.

Kidney cancer that’s found early, before it has spread to other parts of the body, can be treated more easily. It can even be cured with treatment.

What are the treatment options for renal cell carcinoma?

Treatment for renal cell carcinoma depends on a person’s cancer stage and cancer type. There are actually several types of renal cell carcinoma. Clear cell renal carcinoma is the most common type so a lot of information about treatment is about this type of kidney cancer. There are many subtypes of nonclear cell renal cell carcinoma and these are more rare, so there’s less information about treatment for these types of kidney cancers. 

The options below describe treatments for people with stage 1, 2, or 3 clear cell renal carcinoma. If you’ve received a diagnosis of advanced renal cell carcinoma your treatment plan will include different options. Nonclear renal cell carcinoma is also not covered in these options. 

You can learn more about treatment options for all types of renal cell carcinoma by connecting with the Kidney Cancer Association's patient liaison.

Surgery

Surgery is the main form of treatment for people with stage 1, 2, or 3 renal cell carcinoma. During surgery, people have either part or all of their kidney removed, which also removes the tumor and cancer cells. This is called a partial or total nephrectomy. 

A nephrectomy is a major surgical procedure, but it’s safe and complication rates are low.  Nephrectomy can be either radical (when the whole kidney is removed) or partial (only the cancer and a small amount of the kidney that’s not affected by cancer is removed).

Some people can have a nephrectomy via minimally invasive surgery, which speeds up recovery time. People may need to stay in the hospital for 2 to 7 days after surgery, but it can take 6 to12 weeks to fully recover from surgery. 

Surveillance

Active surveillance is a type of treatment used in renal cell carcinoma and other forms of cancer.

Some small renal masses or renal cell carcinomas can be safely observed if they’re smaller than 3 cm and grow slowly over time.

If you’re a candidate for active surveillance, you won’t have surgery or other treatments right away. Instead, you’ll receive regular monitoring of your tumor with imaging and blood tests. If your tumor starts to grow, then you’ll start treatment with surgery or other options like ablation. By using active surveillance, people can avoid surgery and side effects from treatment for years. Active surveillance is an option for people with stage 1a and some people with stage 1b renal cell carcinoma. 

People with stage 1, 2, and 3 renal cell carcinoma who receive other forms of treatment will also need treatment with surveillance. This means that after surgery, you’ll need regular follow-up with your healthcare team to make sure your cancer isn’t coming back. This includes regular blood work and imaging studies. Right now, imaging studies are the best way to determine if renal cell carcinoma is in remission or is returning (relapsing).

Ablative therapy

Ablative therapy uses different types of energy to destroy cancer cells. There are several types of ablative therapy including:

• Cryotherapy: This uses cold temperatures to destroy cancer cells.

• Microwave: It uses electromagnetic waves to destroy cancer cells.

• Radiofrequency: It uses heat to destroy cancer cells.

Ablative therapy can be used before surgery to shrink the tumor and make it easier to remove. People with small stage 1a renal cell carcinoma may be able to use ablative therapy instead of surgery.

Adjuvant therapy

Adjuvant therapy are medications given after surgery to people who are at higher risk for relapse. You may be a candidate for adjuvant therapy if you have:

• A higher grade (more advanced) tumor

• Cancer cells in your lymph nodes

• Resected stage 4 cancer

Taking these medications after surgery can lower the risk of renal cell cancer coming back. But it’s not clear if these treatments help people live longer. There are two FDA-approved adjuvant therapies for renal cell carcinoma:

• Keytruda (pembrolizumab): Keytruda is a type of immunotherapy. It helps your immune system fight off cancer. In people who are at high risk for relapse, studies show that Keytruda treatment can help people live longer and lowers the risk of cancer coming back. Keytruda is given through intravenous (IV) infusion every 3 to 6 weeks for 1 year after surgery to reduce the risk of relapse. Keytruda is the only type of immunotherapy that has been shown to reduce kidney cancer relapse.

• Sutent (sunitinib): Sutent is a type of targeted therapy that stops cancer cells from growing. In studies, people who received Sutent after surgery were less likely to have a cancer relapse. Sutent is taken by mouth on a 4-week on, 2-week off schedule for 1 year to reduce the risk of relapse. Some studies have shown benefits, and others have not. This treatment is controversial and not always recommended. 

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Written by:

Tracy Norfleet, MD, FACP

Dr. Tracy Norfleet is a board-certified Internal Medicine physician, health expert, and physician leader with over 20 years of experience practicing adult medicine. Dual-certified by the American Board of Obesity Medicine and the American Board of Lifestyle Medicine, Dr. Tracy possesses a wealth of knowledge and expertise in both traditional medical practices and innovative lifestyle interventions for chronic disease management and reversal.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Andrew J. Armstrong, MD, ScM

Andrew J. Armstrong, MD, ScM, is a tenured professor of medicine, surgery, pharmacology, and cancer biology and director of research for Duke Cancer Institute’s Center for Prostate and Urologic Cancers.

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