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
Early kidney cancer (stage 1 or 2) is localised. That means the cancer is found in the kidney only. The main treatment for early kidney cancer is surgery.
Less often, thermal ablation, cryotherapy and stereotactic body radiation therapy are used. Sometimes the best approach for early kidney cancer is to watch the cancer over time.
“I could choose between open and laparoscopic surgery. I knew our hospital had a good track record with laparoscopy and that I would have a quicker recovery so I chose this option. I was only in hospital for one-and-a-half days. I felt better in 2 weeks and was back to driving in 3 weeks, although it took a few months to feel back to normal.” Chris
Active surveillance
Your doctor may suggest monitoring the cancer closely rather than starting treatment. This approach is known as active surveillance.
The aim is to maintain kidney function and avoid unnecessary treatment, while looking for changes that mean treatment should start.
Active surveillance may be suggested if the tumour is less than 4 cm in size. It might also be an option if you are not well enough for surgery and the tumours are small, or if you are older.
Active surveillance options involve having regular ultrasounds or CT scans. If these imaging tests suggest that the tumour has grown, you may be offered active treatment (usually surgery). Ask your doctor how often you need check-ups.
Choosing active surveillance avoids treatment side effects, but you might feel anxious about having a cancer diagnosis without active treatment. Talk to your doctors about ways to manage any worries.
Contact cancer support
Surgery
Surgery is the main treatment for early kidney cancer. Depending on the type of kidney cancer, the grade and stage of the cancer, and your general health, you might have surgery to remove part or all of a kidney.
Types of surgery
- Partial nephrectomy – This removes the cancer and a small part of the surrounding tissue, leaving some healthy tissue in the affected kidney. This operation may be recommended for tumours smaller than 7 cm that are in the kidney only. It may also be used for people who have existing kidney disease, cancer in both kidneys, or only one working kidney. A partial nephrectomy is a more complex operation than a radical nephrectomy. Whether it is possible depends on where the tumour is in the kidney, as well as the expertise of the surgeon and hospital.
- Radical nephrectomy – The whole affected kidney, a small part of the ureter and the surrounding fatty tissue are removed. The adrenal gland and nearby lymph nodes might also be removed. This is the most common operation for large tumours. Sometimes the kidney cancer may have spread into the renal vein and even into the vena cava, the large vein that takes blood to the heart. Even if the cancer has spread to the vena cava, it is sometimes possible to remove all the cancer in one operation.
- The remaining kidney – If a whole kidney or part of a kidney is removed, the remaining kidney usually does the work of both kidneys. Your doctor will talk to you about how to keep the remaining kidney healthy, which may include taking steps to reduce your risk of high blood pressure, heart problems and diabetes.
How the surgery is done
If you have kidney cancer surgery, it will be carried out in hospital. A nephrectomy is a major operation and you will be given drugs (general anaesthetic) to put you to sleep and temporarily block any pain or discomfort during the surgery.
One of the following methods will be used to remove part or all of the kidney (partial or radical nephrectomy). The method recommended for you will depend on the size and location of the tumour and your general health.
Your surgeon will talk to you about the risks of the procedure.
- Open surgery – This is usually done with a long cut (incision) at the side of your abdomen where the affected kidney is located. In some cases, the incision is made in the front of the abdomen or in another area of the body where the cancer has spread. If you are having a radical nephrectomy, the surgeon will clamp off and divide the major blood vessels and tubes to the affected kidney before removing it.
- Keyhole surgery – This is also called minimally invasive surgery or laparoscopic surgery. The surgeon will make a few small cuts in the skin, then insert a tiny instrument with a light and camera (laparoscope) into one of the cuts. The surgeon inserts tools into the other cuts to remove the cancerous tissue or kidney, using images from the camera as a guide.
- Robot-assisted surgery – This is a type of keyhole surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and moves robotic arms that hold the instruments. Robotic surgery has meant that more partial nephrectomies can be performed with keyhole surgery, reducing complications and improving recovery time.
What to expect after surgery
After a nephrectomy, you will usually be in hospital for 2–7 days, but it can take 6–12 weeks to fully recover.
Your recovery time will depend on the type of surgery you had, your age and general health. Once you are home, you will need to take some precautions.
- Drips and tubes – while in hospital, you will be given fluids and medicines through a tube inserted into a vein (intravenous drip). You will also have other temporary tubes to drain waste fluids away from the operation site. For a few days, you will most likely have a thin flexible tube inserted in your bladder that is attached to a bag to collect urine. This is called a urinary catheter. Knowing how much urine you are passing helps hospital staff monitor how the remaining kidney is working. When the catheter is removed, you will be able to urinate normally again.
- Blood clots – you will usually have to wear compression stockings to help the blood in your legs circulate and prevent blood clots developing. Depending on your risk of clotting, you may be given daily injections of a blood-thinning medicine.
- Pain relief – you will have some pain and discomfort for several days after kidney surgery. This will be managed with pain medicines. You may be given tablets or injections, or you may have patient-controlled analgesia (PCA), which delivers a measured dose of pain medicine through a drip when you press a button. If you still have pain, let your doctor or nurse know so they can change your medicine as needed.
- Moving around – your health care team will probably encourage you to walk the day after the surgery. A physiotherapist may show you exercises to do while you are recovering and explain how to move safely. Doing breathing or coughing exercises can help you avoid developing a chest infection. It will be some weeks before you can lift heavy things, reach your arms overhead or drive. Ask your doctor how long you should wait before attempting any of these activities or returning to work.
- Returning home – when you get home, you will need to take things easy and only do what is comfortable. Let your family and friends know that you need to rest a lot and might need some help around the house. To help your body recover from surgery, try to eat a balanced diet (including proteins including lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds, and legumes such as beans).
- Check-ups – you will need to visit your surgeon for a check-up a few weeks after you’ve returned home. You will usually leave the hospital with the details of your appointment. If you haven’t been given an appointment time, check with your surgeon’s rooms.
Making decisions about surgery
Talk to your surgeon about the types of surgery suitable for you. Ask about the advantages and disadvantages of each method.
There may be extra costs involved for some procedures and they are not all available at every hospital.
Compared to open surgery, both keyhole (laparoscopic) surgery and robot-assisted surgery usually mean a shorter hospital stay, less pain and a faster recovery time.
In some cases, open surgery may be a better option.
Learn more
Other treatments
If surgery is not the best approach, non-surgical treatments may be recommended to destroy or control early kidney cancer.
- Thermal ablation – This procedure uses heat to destroy small tumours. The heat may come from radio waves (radiofrequency ablation or RFA) or microwaves (microwave ablation or MWA). The heat kills the cancer cells and forms internal scar tissue. The doctor inserts a fine needle into the tumour through the skin, using a CT scan as a guide. The needle delivers either radio waves or microwaves into the tumour. Thermal ablation is usually done under general anaesthetic in the x-ray department or the operating theatre. The procedure itself takes about 15 minutes and you can usually go home after a few hours. Side effects, including pain or fever, can be managed with medicines.
- Cryotherapy – Also known as cryosurgery, cryotherapy kills cancer cells by freezing them. Under a general or spinal anaesthetic, a cut is made in the abdomen and multiple probes are inserted into the tumour. The probes get very cold, which freezes and kills the cancer cells. Cryotherapy takes about 60 minutes. You may have some bleeding and discomfort afterwards.
- Stereotactic body radiation therapy (SBRT) – This specialised form of radiation therapy is also called stereotactic ablative body radiation therapy (SABR). It is a way of giving a highly focused dose of radiation therapy to an early kidney cancer when surgery is not possible. If you have SBRT, you will lie on a treatment table under a machine that directs radiation beams from outside the body to the kidney. SBRT is painless and is usually delivered over 1–3 days.