Page last updated: December 2024
The information on this webpage was adapted from Understanding Kidney Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in December 2024.
Expert content reviewers:
This information was developed based on international clinical practice guidelines, and with the help of a range of health professionals and people affected by kidney cancer:
- Dr Alarick Picardo, Urologist, Fiona Stanley Hospital, WA
- Heidi Castleden, Consumer
- Donna Clifford, Urology Nurse Practitioner, Royal Adelaide Hospital, SA
- Mike Kingsley, Consumer
- Prof Paul De Souza, Medical Oncologist and Professor of Medicine, Nepean Cancer Care Centre, The University of Sydney, NSW
- Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC
- Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA
- Luke O’Connor, Urology Nurse, Royal Brisbane and Women’s Hospital, QLD
- A/Prof Shankar Siva, Radiation Oncologist and Cancer Council Victoria Colebatch Fellow, Peter MacCallum Cancer Centre, VIC
- A/Prof Homi Zargar, Uro-Oncologist and Robotic Surgeon, Western Health and Royal Melbourne Hospital, VIC
When kidney cancer has invaded the major kidney veins or spread to nearby lymph nodes (stage 3 or locally advanced), you may still be able to have surgery to remove the tumour.
If kidney cancer has spread outside the kidney to other parts of the body (stage 4 or metastatic), treatment usually aims to slow the spread of the cancer and to manage any symptoms. A combination of different treatments may be recommended.
Which combination is suitable for you will depend on several things, including how soon after diagnosis you start drug therapies, as well as your blood counts, blood calcium levels and general health.
Speaking to a counsellor about your feelings and individual situation can be helpful. You can also call Cancer Council 13 11 20 to talk to a health professional about your concerns.
Active surveillance
In some cases, kidney cancer grows so slowly that it won’t cause any problems for a long time.
Because of this, especially if the advanced kidney cancer has been found unexpectedly, your doctor may suggest looking at the cancer regularly, usually with CT scans.
This approach is known as active surveillance. If the cancer starts to grow quickly or cause symptoms, your doctor may recommend active treatment.
Drug therapies
Targeted therapy
This is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading.
Targeted therapy drugs are usually used as the first treatment for advanced kidney cancer (first-line treatment), often in combination with immunotherapy drugs.
These drugs are usually taken daily as tablets. They may be taken for many months and sometimes even years. There are different drugs available and your medical oncologist will discuss which combination of drugs is best for your situation.
Cancer cells often stop responding to targeted therapy drugs over time. If the first-line treatment stops working, your oncologist may suggest trying another targeted therapy or an immunotherapy drug.
Side effects of targeted therapy drugs
The side effects of targeted therapy will vary depending on the drug used. Common side effects include fatigue, skin rash, mouth sores, nausea, diarrhoea, joint pain and high blood pressure.
Having drug therapies
Drugs can reach cancer cells throughout the body. This is called systemic treatment.
Controlling kidney cancer
Targeted therapy and immunotherapy are the main types of drug therapies used to control advanced kidney cancer. Chemotherapy is rarely used for kidney cancer these days.
The types of drugs and combinations used are rapidly changing as clinical trials show better responses and improved survival with newer drugs.
Accessing new drugs
Talk with your doctor about the latest developments and whether you are a suitable candidate for any new drug treatments. You may also be able to get other drugs through clinical trials.
Cost of drugs
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of some targeted therapy or immunotherapy drugs as long as certain criteria are met.
Medicines or treatments that are not on the PBS are usually very expensive unless given as part of a clinical trial.
Reporting side effects
Your doctors will explain the possible side effects of the different drugs. It is important to tell your treatment team about any side effects you have from drug therapies.
Side effects can be better managed when they are reported early. If left untreated, some can become life-threatening.
Managing side effects
Your doctor may be able to prescribe medicine to prevent or reduce side effects of targeted therapy and immunotherapy drugs.
In some cases, your doctor may delay treatment or reduce the dose to lessen side effects.
Immunotherapy
There have been many advances in treating advanced kidney cancer with immunotherapy drugs known as checkpoint inhibitors. These use the body’s own immune system to fight cancer.
Checkpoint inhibitors may be used at different stages of advanced kidney cancer:
- as the first-line treatment for advanced kidney cancer, either on their own or in combination with targeted therapy drugs
- as a second-line treatment when targeted therapy has stopped working
- as long-term treatment to try to control the cancer’s growth (maintenance treatment).
The drugs are usually given into a vein through a drip (intravenously) and the treatment is repeated every 2–6 weeks.
How many infusions you have depends on how you respond to the drug and whether you have any side effects. You may keep having the drugs for many months and sometimes even years.
The drugs used for kidney cancer are rapidly changing as clinical trials test newer drugs. Your medical oncologist will discuss which combination of drugs is best for your situation.
Side effects of immunotherapy
The side effects of immunotherapy can vary – not everyone will react in the same way. Immunotherapy can cause inflammation in any of the organs of the body.
This can cause side effects such as fatigue, skin rash, joint pain and diarrhoea. The inflammation can lead to more serious side effects in some people, but this will be monitored closely and managed quickly.
Looking after yourself
Cancer can cause physical and emotional strain, so it's important to look after your wellbeing by:
Contact cancer support
Radiation therapy
Radiation therapy uses a controlled dose of radiation to kill or damage cancer cells.
Conventional external beam radiation therapy may be used if you are not able to have surgery. It may also be used in advanced kidney cancer to shrink a tumour and relieve symptoms such as pain and bleeding (palliative treatment).
Some people may have stereotactic body radiation therapy (SBRT) to treat tumours that have spread. This may be offered when the cancer has spread to only a few places outside the kidney.
If you have radiation therapy, you will lie on a treatment table under a machine called a linear accelerator. The machine directs radiation beams from outside the body to the kidney.
The treatment is painless and takes only a few minutes. The total number of treatment sessions depends on your situation. Each session usually lasts for 10–20 minutes.
You will be able to go home once the session is over, and in most cases you can drive afterwards.
Side effects of radiation therapy
You might have some temporary side effects, such as fatigue, nausea, loss of appetite, diarrhoea, tiredness and skin irritation.
The radiation oncologist can talk to you about possible side effects and ways to manage them.
“My greatest concern has been about the cancer coming back. For a while it was my first waking thought. Time has helped me deal with this.” Jodie
Surgery
Surgery to remove kidney cancer that has spread is known as cytoreductive surgery. Generally, surgery is not recommended if you are unwell or if the cancer has spread to many places in the body.
Two types of cytoreductive surgery may be possible in some situations:
- nephrectomy – to remove the primary cancer in the kidney. This may be offered when the kidney cancer is causing symptoms or when there is very little cancer spread outside the kidney. It can also be used in some people who have responded well to systemic treatment
- metastasectomy – to remove some or all of the tumours that have spread. This may be offered when the cancer has spread to only a few places outside the kidney.
Palliative treatment
In some cases of advanced kidney cancer, the medical team may talk to you about palliative treatment.
This is treatment that aims to slow the spread of cancer and relieve symptoms without trying to cure the disease.
You might think that palliative treatment is only for people at the end of their life, but it may help at any stage of advanced cancer.
It is about living for as long as possible in the most satisfying way you can. Treatments given palliatively for advanced kidney cancer may include:
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, practical, cultural, social and spiritual needs.
The team also provides support to families and carers.
Learn more
Follow-up appointments
After treatment for early kidney cancer, you will have regular appointments to monitor your health, manage any long-term side effects and check that the cancer hasn’t come back or spread.
During these check-ups, you will usually have a physical examination and you may have ultrasounds, CT scans or blood tests.
Your doctor will talk to you about the follow-up schedule, which will depend on the risk of the cancer coming back. If you have advanced kidney cancer, you will have appointments with your treatment team on an ongoing basis.
When a follow-up appointment or test is approaching, many people find that they think more about the cancer and may feel anxious. Talk to your treatment team or call Cancer Council 13 11 20 if you are finding it hard to manage this anxiety.
Check-ups will become less frequent if you have no further problems. Between follow-up appointments, let your doctor know immediately of any symptoms or health problems.
What if the cancer returns?
For some people, kidney cancer does come back after treatment, which is known as a recurrence. It is important to have regular check-ups, so that if cancer does come back, it can be found early.
If the cancer recurs in the kidney (after a partial nephrectomy), you may be offered more surgery.
If the cancer has spread beyond the kidney, your doctor may suggest targeted therapy, immunotherapy or radiation therapy, or occasionally, surgery.
Question checklist
Asking your doctor questions will help you make an informed choice. You may want to include some of the questions below in your own list:
Diagnosis
- What type of kidney cancer do I have?
- Has the cancer spread? If so, where has it spread? How fast is it growing?
- Are the latest tests and treatments for this cancer available in this hospital?
- Will a multidisciplinary team be involved in my care?
- Are there clinical guidelines for this type of cancer?
Treatment
- What treatment do you recommend? What is the aim of the treatment?
- Are there other treatment choices for me? If not, why not?
- If I don’t have the treatment, what should I expect?
- How long do I have to make a decision?
- I’m thinking of getting a second opinion. Can you recommend anyone?
- How long will treatment take? Will I have to stay in hospital?
- Are there any out-of-pocket expenses not covered by Medicare or my private health cover? Can the cost be reduced if I can’t afford it?
- How will we know if the treatment is working?
- Are there any clinical trials or research studies I could join?
Side effects
- What are the risks and possible side effects of each treatment?
- Will I have a lot of pain? What will be done about this?
- Can I work, drive and do my normal activities while having treatment?
- Will the treatment affect my sex life and fertility?
- Should I change my diet or physical activity during or after treatment?
- Are there any complementary therapies that might help me?
After treatment
- How often will I need check-ups after treatment?
- Who should I go to for my check-up appointments?
- If the cancer returns, how will I know? What treatments could I have?
