Skip to content

Treatment for kidney cancer

Preparing for treatment

Talk with your doctors about whether you need to do anything to prepare for treatment and help your recovery.

They may suggest that you exercise, eat a healthy diet or drink less alcohol. You may also find it helpful to talk to a counsellor about how you are feeling.

If you smoke, you will be encouraged to stop. Research shows that quitting smoking before surgery reduces the chance of complications. To work out a plan for quitting, talk to your doctor or call the Quitline on 13 7848.

Preparing for treatment in this way – called prehabilitation – may improve your strength, help you cope with treatment side effects and improve the results of treatment.

Treatment for early kidney cancer

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.

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 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). Ask your doctor how often you need check-ups.

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.

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.

Image showing an example of how a partial nephrectomy is done

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.

Image showing an example of how a radical nephrectomy is done

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 surgery for kidney cancer, 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 3-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.

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. But in some cases, open surgery may be a better option.

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.

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.

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.

Moving around – Your health care team will probably encourage you to walk the day after the surgery. A physiotherapist may explain how to move safely and show you exercises to do while you are recovering. 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 such as 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.

Download our booklet ‘Understanding Surgery’

If surgery is not the best approach, other 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.


Also known as cryosurgery, cryotherapy kills cancer cells by freezing them. This treatment is not widely used in Australia. Under a general anaesthetic, a cut is made in the abdomen. The doctor inserts a probe through the cut into the tumour. The probe gets very cold, which freezes and kills the cancer cells. Cryotherapy takes about 60 minutes. You may have some bleeding or leakage of urine 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.

Treatment for advanced kidney cancer

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 systemic treatment, as well as your blood counts, blood calcium levels and general health.

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.

Having systemic treatment

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 systemic treatment 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. 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.

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 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

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.

Managing side effects of drug therapies

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.

Download our fact sheet ‘Understanding Targeted Therapy’

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.

Download our fact sheet ‘Understanding Immunotherapy’

Also known as radiotherapy, 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.

Some people may have stereotactic body radiation therapy (SBRT) to treat 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.

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 – 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.

Download our booklet ‘Understanding Radiation Therapy’

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.

Download our booklet ‘Understanding Surgery’

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 radiation therapy, arterial embolisation (a procedure that can reduce blood in the urine by blocking the blood supply to the tumour), targeted therapy or immunotherapy.

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.

Download our booklet ‘Understanding Palliative Care’

Download our booklet ‘Living with Advanced Cancer’

Featured resource

Understanding Kidney Cancer

Download PDF

This information is reviewed by

This information was last reviewed November 2022 by the following expert content reviewers: 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.