Kidney Cancer (Renal Cell Carcinoma)
Many kidney cancers are now found by chance — on a scan done for something else. That's a quiet revolution: tumours caught small, surgery offered while still curative, and a growing arsenal of effective drugs for when surgery alone isn't enough.
What kidney cancer is — in plain words
Renal cell carcinoma (RCC) is the most common kidney cancer in adults — accounting for about 90% of cases. It begins in the cells lining the tiny tubes that filter blood inside the kidney. The most common subtype is clear cell RCC; less common subtypes (papillary, chromophobe, others) behave differently and are managed with attention to those differences.
Risk factors include smoking, obesity, high blood pressure, long-standing kidney disease (especially on dialysis), and a small number of inherited conditions (von Hippel-Lindau syndrome, hereditary papillary RCC).
Signs and symptoms to take seriously
Most early kidney cancers cause no symptoms — which is why so many are found incidentally on a CT or ultrasound. When symptoms do appear, they can include:
Blood in the urine
Visible or microscopic. Even a single episode of visible blood in urine without a clear infection warrants imaging.
Flank or back pain
A dull, persistent ache in the side, often below the ribs.
A palpable mass
A lump in the flank or abdomen — usually a late finding.
Systemic symptoms
Unexplained weight loss, fevers, night sweats, anaemia, or high calcium on blood tests.
"The phrase 'incidental kidney mass' is one of the happier reasons a patient walks into my clinic. Caught early, kidney cancer is often a problem we can solve with a single, well-planned operation."
How kidney cancer is diagnosed
- Imaging — CT or MRI with contrast is usually enough to characterise a kidney mass and assess whether it has spread.
- Biopsy — not always needed if imaging is clearly characteristic and surgery is planned. Useful for smaller tumours where active surveillance is considered, or for confirming diagnosis when systemic treatment is planned.
- Staging — chest CT, abdominal imaging, sometimes bone scan and brain MRI if symptoms suggest spread.
- Blood and urine tests — kidney function, blood counts, calcium, urine analysis.
Stages — what the numbers mean
Stage I
Tumour 7 cm or less, confined to the kidney. Often curable with surgery alone. Five-year survival above 90%.
Stage II
Tumour larger than 7 cm, still confined to the kidney. Surgery, with adjuvant immunotherapy considered for higher-risk features.
Stage III
Spread to nearby tissues, the renal vein, or local lymph nodes. Surgery plus adjuvant therapy for selected patients.
Stage IV (metastatic)
Spread to distant organs — lung, bone, liver, brain. Treated with systemic therapy, with surgery considered in selected cases.
How we treat kidney cancer
Surgery
The cornerstone of treatment for localised kidney cancer.
- Partial nephrectomy — removing just the tumour and a margin of normal kidney, preserving the rest. Preferred for smaller tumours when feasible.
- Radical nephrectomy — removing the entire kidney. Used for larger or more complex tumours.
Many of these operations are now done laparoscopically or robotically with shorter recovery and excellent outcomes.
Active surveillance
For small (under 4 cm) kidney masses, especially in older or frail patients, careful imaging surveillance is a legitimate option. Many of these tumours grow very slowly and may never require intervention.
Ablation
Radiofrequency or cryoablation can treat small kidney tumours in patients who are not surgical candidates, with good local control.
Adjuvant immunotherapy
Pembrolizumab given for a year after surgery improves outcomes in patients at high risk of recurrence (large tumour, nodal involvement, or fully resected oligometastatic disease).
Systemic therapy for advanced disease
The standard first-line treatment for advanced clear cell RCC is a combination of an immune checkpoint inhibitor with either a tyrosine kinase inhibitor (TKI) or another checkpoint inhibitor:
- Pembrolizumab + axitinib
- Pembrolizumab + lenvatinib
- Nivolumab + cabozantinib
- Nivolumab + ipilimumab (dual immunotherapy, particularly for intermediate- and poor-risk disease)
The choice is individualised. Read more about immunotherapy →
Targeted therapy (TKIs)
Sunitinib, pazopanib, axitinib, cabozantinib and lenvatinib all target the abnormal blood-vessel signalling that fuels kidney cancers. They are taken as daily tablets, with side effects (fatigue, hand-foot syndrome, blood pressure changes, diarrhoea, thyroid changes) that are usually manageable with dose adjustment.
Chemotherapy
Traditional chemotherapy plays a limited role in kidney cancer, except for specific aggressive subtypes (sarcomatoid, collecting duct). Read more about chemotherapy →
Cytoreductive nephrectomy
Removing the primary kidney tumour in selected patients with metastatic disease can still play a role, particularly when most of the cancer burden is in the kidney and the patient is fit. The decision is individualised in the era of effective systemic therapy.
What the outlook honestly looks like
For stage I kidney cancer, five-year survival is well over 90%. For stage III, around 60–70% with proper surgery and adjuvant treatment. For metastatic disease, the landscape has been transformed: median survival on modern immunotherapy combinations has more than doubled in the last decade, and a meaningful minority of patients achieve durable, complete remissions.
Prevention and early detection
- Stop smoking — a clear and modifiable risk factor.
- Manage blood pressure and weight — both contribute to kidney cancer risk.
- Screen high-risk patients — those on long-term dialysis, with von Hippel-Lindau syndrome, or with other hereditary kidney cancer syndromes.
Life during treatment
Recovery from kidney surgery is usually quick — most patients are home within a few days for laparoscopic operations. Oral targeted therapies allow life at home with regular clinic checks. Immunotherapy infusions are typically every 3–6 weeks and well tolerated by most patients. Side effects are managed actively — we'd rather adjust a dose than have a patient stop a treatment that is working.
After treatment — survivorship
Surveillance imaging continues for years after curative surgery, with frequency tailored to risk. Kidney function is monitored. Long-term effects of systemic therapy (especially endocrine effects of immunotherapy) are followed in clinic. Read about survivorship care →
A kidney mass found on a scan? Let's review what it means.
Bring the imaging, any biopsy report, your kidney function tests, and a list of your medications. We will explain the options — observation, surgery or systemic treatment — and what would suit your specific situation.
Medically reviewed by
Dr. Rehan Abdullah
Dr. Rehan Abdullah is a dual-trained clinical and radiation oncologist with over a decade of experience treating both solid tumours and hematologic malignancies. He serves as Consultant Oncologist at INMOL Hospital and sees patients at Farooq Hospital and Healthnox Medical Center, Lahore. Read full profile →
This page is patient education, not a substitute for an in-person consultation. Cancer care must be individualised. Read our medical disclaimer →