# Treatment methods for kidney cancer
Treatment of kidney cancer depends greatly on how advanced the disease is, the size and location of the tumor, and how well the heart, kidneys and other organs function. This tab describes standard treatments by stage.
Surgical removal (all stages)
ProveniIncluded in official guidelines, or approved by EMA or FDA
Surgical removal of the tumor is the first step for many patients. The surgeon can remove the entire kidney (nephrectomy) or, if the tumor is small and localized, only the affected part (partial nephrectomy). Sometimes surrounding tissue or nearby lymph nodes are also removed, especially if there is suspicion that the cancer has spread.
The operation is performed under general anesthesia. Complications can include abdominal bleeding, infections or damage to neighboring organs. After surgery, recovery usually takes from several weeks to months, depending on the extent of the procedure. Loss of one kidney — if it still functions well — usually does not significantly limit kidney function, because the other kidney can often compensate sufficiently.
When the tumor has spread into the renal blood vessel or further, the operation may be more complex and take longer. Recent research shows that good planning with imaging (such as MRI) before surgery helps determine the best surgical plan.
Immunotherapy (advanced stage)
ProveniIncluded in official guidelines, or approved by EMA or FDA
For cancer that has spread to other parts of the body (metastases) or cannot be operated on, immunotherapies are widely used. These medicines help the body's own immune system better recognize and attack cancer cells.
The most common immunotherapies for kidney cancer are checkpoint inhibitors. These block certain brakes on immune cells, allowing them to work better. They are usually administered by infusion. Known side effects include fatigue, skin rash, joint or muscle pain, and less frequently inflammatory reactions in the lungs, liver or intestines. These side effects can sometimes be serious and require close monitoring by the treating physician.
Immunotherapy does not work equally well for everyone. Sometimes immunotherapy is combined with targeted medicine (see below) to strengthen the effect. Recent research shows that certain genetic characteristics of the tumor can predict who will respond better to immunotherapy.
Targeted medicine against growth factors (advanced stage)
ProveniIncluded in official guidelines, or approved by EMA or FDA
This class of medicines inhibits proteins that help tumor cells grow and obtain nutrition (via new blood vessels). They are usually taken as a pill.
The most commonly used are tyrosine kinase inhibitors (TKI). These block proteins that transmit signals for cell growth. Known side effects include high blood pressure, diarrhea, fatigue, hand-foot-skin reactions (redness and pain in hands and feet), and decrease in white blood cells. These medicines can also affect the thyroid.
Another targeted medicine is mTOR inhibitor (everolimus). This blocks a protein that stimulates cancer cell growth. Side effects include mouth ulcers, lung inflammation, high blood sugar, and decrease in blood cells.
These targeted medicines are often used after immunotherapy, or in combination. Recent studies show that certain combinations (for example lenvatinib plus pembrolizumab) can be effective, although side effects may be more intensive.
Combination therapy: immunotherapy and targeted medicine (advanced stage)
ProveniIncluded in official guidelines, or approved by EMA or FDA
For patients with advanced kidney cancer, a combination of immunotherapy and targeted medicine is regularly used, especially as first-line treatment. This can work better than one medicine alone.
The combination of two immunotherapies (two checkpoint inhibitors) is, for example, proven effective. Combinations of immunotherapy with TKI (such as bevacizumab, an agent against blood vessel growth, plus immunotherapy) are also widely applied.
Side effects can be cumulative: fatigue, diarrhea, high blood pressure, skin and inflammatory reactions can all occur. Sometimes the dose needs to be adjusted or a medication from the combination stopped if side effects become too severe. Regular contact with the treating physician is essential to keep this well balanced.
Neoadjuvant therapy (before surgery, special case)
ResearchediPositive results in clinical studies, not yet standard treatment
In certain situations – when the tumor is large or located close to important blood vessels – immune or targeted medication can be given before surgery to shrink the tumor and make the operation safer.
This is called neoadjuvant therapy. Studies are ongoing to determine which patients benefit most from this and which medication combinations work best. Preliminary results are positive, but this is not yet standard treatment for all patients.
Adjuvant therapy (after surgery, preventive)
ResearchediPositive results in clinical studies, not yet standard treatment
Some patients receive medications after successful surgery to reduce the risk of recurrence or metastases.
This can be immunotherapy (checkpoint inhibitors) or targeted medication. Recent studies show that certain patients – especially those with tumors with certain risk factors (large size, aggressive form) – may benefit from adjuvant immunotherapy.
Side effects are the same as with regular use of these medications. Treatment usually lasts for months. Whether this actually leads to longer survival is still being investigated; this is therefore not yet standard for everyone.
Observation of small tumors
ProveniIncluded in official guidelines, or approved by EMA or FDA
When a small kidney tumor is found by chance (smaller than 4 centimeters) and the patient has no complaints, 'active surveillance' can be chosen: regular imaging (CT or ultrasound) to see if the tumor grows, without immediate surgery.
This helps prevent overtreatment, because many small tumors grow very slowly or not at all. If the tumor does grow, it can still be treated. However, this requires good contact with the specialist and appointments to ensure it does not go out of control.
Local minimally invasive treatments
Under investigation to Proven
For small tumors, alternatives to complete surgery can sometimes be considered:
- **Radiofrequency ablation (RFA)**: a probe is inserted into the tumor and heats it. This kills tumor cells through heat.
- **Cryotherapy**: freezing of the tumor with nitrogen via a probe.
These treatments can be performed under local anesthesia and especially via image-guided puncture. Side effects are generally less than with open surgery. Long-term results are good for very small tumors; for larger tumors surgery is usually more certain.
Experimental approaches
Much research is being done on newer treatments for kidney cancer, including in clinical trials:
- **Other immunotherapies**: new types of checkpoint inhibitors and CAR-T cell therapy (in which immune cells are genetically modified).
- **Cuproptosis approaches**: this is a new type of cell death that can be triggered in cancer cells via routes other than standard therapy.
- **Nanoparticle approaches**: the use of nanoparticles to deliver medications better into tumor cells.
These are still in studies; availability is limited to participation in research programs.
Additional supportive measures
Regardless of primary treatment, patients often receive support for side effects and general well-being:
- Nutritional guidance (because some medications affect appetite).
- Treatment of high blood pressure, inflammatory reactions or other complications.
- Psychological support and conversations about lifestyle.
- Regular monitoring of kidney function and blood values.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._