Active surveillance
It may seem strange, but for some people with small kidney tumours, the first best treatment is often observation, or active surveillance.
If you are older, or have significant medical problems, it may be safer to first carefully watch the cancer, with multiple scans and multiple visits to the cancer specialist. Because many kidney cancers are discovered by accident on scans that were recommended for other reasons, a number of small kidney lumps are now being detected. Kidney cancers that are smaller than 3 cm are very unlikely to spread elsewhere, and sometimes the risks of an operation outweigh the benefits of surgery. People who choose active surveillance with their doctors must continue to have regular follow-up care and scans, in case the cancer starts to grow.
Surgery
If you have a larger cancer in the kidney, surgery is usually the first best treatment. Surgery to remove kidney cancers is performed by a specialist surgeon called a Urologist or Urooncologist (a Urologist who specialises in cancer). Surgery may either remove just a part of the kidney (called a partial nephrectomy) or the entire kidney, which is called a radical nephrectomy. Surgery might need to be done with an incision under the ribs (a flank incision) or in the upper abdomen (an open nephrectomy) or might be able to be done by keyhole surgery (a laparoscopic nephrectomy) which results in a shorter hospital stay and quicker recovery.
If the cancer is small (stage 1, <7cm) a partial nephrectomy may be possible, where the remaining normal kidney can be spared. If the cancer is larger (stage 2), or has started to spread near the kidney (stage 3) then the whole kidney is removed.
Treating a localised kidney cancer without surgery
In some people, an operation is not the best choice and other, less invasive treatments could be used to treat a localised kidney cancer. These include:
Radiofrequency ablation (RFA): where a needle containing a microwave antenna is inserted into the cancer under local anaesthetic, and the cancer is cooked from the inside.- Cryoablation: where a series of probes are inserted into the cancer, and then cooled with liquid nitrogen to freeze the cancer cells. This has a similar effect as RFA but may require a general anaesthetic.
Stereotactic body radiation therapy (SBRT): this newer, computer-controlled radiation has been tested in kidney cancer and many other cancers. SBRT gives lots of very small doses of radiation from a lot of different angles, such that a therapeutic dose of radiation lands on the cancer, but the normal organs and tissues around the cancer are only slightly affected.
Approaches to rare kidney cancers
If you have one of the inherited types of kidney cancer, it is possible you may get more kidney tumours in the future. Because of this, your healthcare team might suggest a different approach for you. Patients with inherited types of kidney cancer need a long-term strategy and so should be seen by an expert in kidney cancer whenever possible.
