Early kidney cancer (stage 1 or 2) is localised, which means the cancer is found in the kidney only or has not spread very far.
The main treatment is surgery. Less often, radiofrequency ablation, cryotherapy and stereotactic body radiation therapy are used. Sometimes the best approach for early kidney cancer is to watch the cancer over time (active surveillance).
If you are a current smoker, your health care team will advise you to stop smoking before you start treatment. To work out a plan for quitting, talk to your doctor or call the Quitline on 13 7848.
Also known as observation, active surveillance is a way of monitoring kidney cancer. The aim is to avoid affecting how your kidney works and other side effects you may experience if you have surgery. It may be suggested if the tumour is less than 4 cm in diameter, if you are not well enough for surgery and the tumours are small, or if you are older.
Active surveillance involves having regular ultrasounds or CT scans. If these imaging tests suggest that the tumour has grown, you may be offered active treatment (usually surgery).
You might feel anxious about having a cancer diagnosis without active treatment. Talk to your doctors about ways to manage any worries.
Surgery is the main treatment for early kidney cancer. You may have surgery to remove part or all of a kidney, depending on the type of kidney cancer, the grade and stage of the cancer, and your general health.
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 reducing your risk of high blood pressure, heart problems and diabetes.
Types of surgery
Partial nephrectomy – This is the most common operation for tumours 7 cm or smaller that are found only in the kidney. It may also be used for people who have existing kidney disease, cancer in both kidneys or only one working kidney. Only the cancer and a small part of the surrounding kidney are removed.
A partial nephrectomy is a more difficult operation than a radical nephrectomy. Whether it is possible depends on where the tumour is in the kidney.
Radical nephrectomy – This is the most common operation for large tumours. 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.
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.
How the surgery is done
If you have surgery for kidney cancer, it will be carried out in hospital under a general anaesthetic. Your surgeon will talk to you about any risks. One of the following methods will be used to remove part or all of the kidney:
- Open surgery – this is usually done with a long cut (incision) at the side of your abdomen where the affected kidney is located. 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 several small cuts in the skin and insert a tiny instrument with a light and camera (laparoscope) into one of the openings, which sends images of your body to a video monitor. The surgeon watches the images on the monitor for guidance during the operation.
- Robot-assisted surgery – this is a type of keyhole surgery using a robotic device. The surgeon sits at a control panel to see a three-dimensional image and moves robotic arms that hold the instruments. Robotic surgery has allowed more partial nephrectomies to be performed with keyhole surgery, reducing complications and improving recovery time.
Talk to your surgeon about the types of surgery suitable for you, and the advantages and disadvantages of each method. If your surgeon suggests robot-assisted surgery, check what you have to pay as it can be a more expensive operation.
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. But in some cases, open surgery may be a better option.
What to expect after surgery
After surgery, you will usually be in hospital for 2–7 days. Once you are home, you will need to take some precautions while you recover. Your recovery time will depend on your age, general health and the type of surgery that you had.
- Drips and tubes – while in hospital, you will be given fluids and medicines via a tube inserted into a vein. For a few days, you will most likely have a thin tube inserted in your bladder that is attached to a bag to collect urine (urinary catheter). Knowing how much urine you are passing helps hospital staff monitor how well 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.
- Pain relief – you will have some pain in the areas where the cuts in the skin were made and where the kidney (or part of the kidney) was removed. If you are in pain, ask for medicine to help control it.
- Moving around – your health care team will probably encourage you to walk the day after the surgery, and may refer you to a physiotherapist while you are in hospital. It will be some weeks before you can lift heavy things, reach high with your arms 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. Try to eat a balanced diet to help your body recover from surgery.
- Check-ups – you will need to visit the hospital for a check-up a few weeks after you’ve returned home.
If you are not well enough for surgery and the tumour is small, other treatments to destroy or control the cancer may be recommended, including:
- 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 procedure is usually done under general anaesthetic and 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. This treatment is not widely used in Australia. Cryotherapy takes about 60 minutes. Side effects include bleeding and leaking urine.
- Stereotactic body radiation therapy (SBRT) – this is also called stereotactic ablative body radiation therapy (SABR) and is a specialised form of radiation therapy. It is a way of giving a highly focused dose of radiation therapy to a primary kidney cancer when surgery is not possible due to other health conditions. SBRT is painless and is usually delivered over one to three days.
Understanding Kidney Cancer
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Expert content reviewers:
A/Prof Daniel Moon, Urologic Surgeon, Australian Urology Associates, and Honorary Clinical Associate Professor, The University of Melbourne, VIC; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Ian Basey, Consumer; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Tina Forshaw, Advanced Practice Nurse Urology, Canberra Health Services, ACT; Dr Suki Gill, Radiation Oncologist, Sir Charles Gairdner Hospital, WA; Karen Walsh, Nurse Practitioner, Urology Services, St Vincents Private Hospital Northside, QLD; Dr Alison Zhang, Medical Oncologist, Chris O’Brien Lifehouse and Macquarie University Hospital, NSW.
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The information on this webpage was adapted from Understanding Kidney Cancer - A guide for people with cancer, their families and friends (2020 edition). This webpage was last updated in September 2021.