Kidney Cancer

Start here

Kidney cancer at a glance

• Renal cell carcinoma (RCC) is the most common kidney cancer in adults. About 9 in 10 adult kidney cancers are RCC.
• Clear-cell RCC is the most common subtype, or type of RCC. Other types include papillary and chromophobe RCC. The subtype can affect how the cancer behaves and which treatments help.
• Many small kidney cancers cause no symptoms and are discovered during a scan for another reason.
• Surgery is the main treatment for most localised RCC, meaning cancer confined to the kidney. A partial nephrectomy removes the tumour while saving the rest of the kidney when this can be done safely.
• Some small tumours can be monitored with regular scans. Other options include ablation, which destroys the tumour using heat or freezing, or focused radiation. These may help when surgery carries more risk.
• Advanced RCC has grown into nearby tissues or spread elsewhere. Treatment often uses immunotherapy to help the immune system attack cancer, targeted medicines that block cancer growth, or both. Traditional chemotherapy has little benefit for most RCC.
• Most people can live a full life with one well-functioning kidney, but blood pressure and kidney function need ongoing care.

A statistic describes a group, not an individual. Ask your doctor what features of your cancer and general health are most relevant to your outlook.

Understand

What your kidneys do

Most people have two kidneys, deep in the upper abdomen on either side of the spine. Each is roughly the size of a fist.

• Tiny filters called nephrons remove waste and extra water from the blood to make urine.
• The kidneys balance fluids, salts and acids, help control blood pressure and signal the body to make red blood cells.
• Urine travels through tubes called ureters to the bladder, where it is stored. The adrenal glands above the kidneys make hormones, the body’s chemical messengers. They are separate organs.

What is kidney cancer?

Cancer begins when abnormal cells keep growing and form a tumour. RCC usually starts in the lining of tiny tubes within the kidney, called tubules, that help form urine.

A kidney mass is an abnormal lump. It may be solid or contain fluid, which is called cystic. Some masses, such as oncocytoma and angiomyolipoma, are benign: they are not cancer.

Scans can suggest the cause. Examining a tissue sample (a biopsy) or tissue removed during surgery may confirm it.

RCC can behave in different ways

• It may remain confined to the kidney for a long time.
• It may grow into nearby fat or lymph nodes, small structures that help fight infection. It may also enter the renal vein, which carries blood away from the kidney, or the vena cava, the large vein that takes this blood towards the heart.
• Cancer cells may travel through the blood or lymphatic system, a network of vessels and nodes. They can form new tumours called metastases, meaning areas of cancer spread. Common sites include the lungs, lymph nodes and bones; the liver or brain can also be affected.

Cancer that started elsewhere and later reached the kidney is a metastasis from the original cancer. It is not classified or treated as primary kidney cancer.

The subtype matters

Histology means the pattern and appearance of cancer cells under a microscope. It is a key part of choosing treatment.

Features your report may mention

• Sarcomatoid or rhabdoid change: the cells look very abnormal and may grow or spread more quickly. These changes can occur within several RCC subtypes.
• Tumour necrosis: areas of dead tumour tissue. The team considers this alongside the other findings in your tissue report, also called a pathology report.
• Clear-cell component: at least part of the cancer has clear-cell features. This can affect which treatments are suitable after surgery.

For a rare subtype, a pathologist who specialises in kidney and urinary tract cancers should review the tissue. A pathologist is a doctor who diagnoses disease by examining cells and tissue. Specialists can then discuss the findings together and recommend a plan.

Symptoms and warning signs

Many kidney cancers cause no symptoms. Having one of these symptoms does not mean you have cancer, but it should be assessed.

Possible symptoms

• Blood in the urine, even if it happens only once
• Persistent pain in the side or back that is not explained by an injury
• A lump or fullness in the side or abdomen
• Unexplained weight loss, poor appetite, ongoing fever or marked tiredness
• Less commonly, anaemia (too few healthy red blood cells), high blood calcium, leg swelling or symptoms caused by spread to another organ

If you are already receiving cancer treatment, use the 24-hour number given by your treating team. Do not wait for the next routine appointment when symptoms are severe or rapidly worsening.

Risk factors

A risk factor increases the chance of developing cancer, but it cannot explain why one person developed it. Usually there is no single cause. Having kidney cancer is not your fault.

Factors that increase risk

• Smoking
• Excess body weight and high blood pressure
• Severe long-term kidney disease, especially when dialysis is needed to filter waste and extra fluid from the blood
• A parent, brother, sister or child with kidney cancer
• Certain inherited conditions, caused by gene changes passed down in a family, and some long-term workplace chemical exposures

Routine screening is not recommended for people at average risk who have no symptoms. People with a confirmed inherited condition that increases kidney cancer risk need a specialist plan for regular checks.

Genetic counselling helps you understand inherited cancer risk and decide whether testing is useful.

Germline testing uses blood or saliva to look for a gene change present throughout the body that may be passed down in a family. It is different from testing the tumour itself. Counselling also helps explain what the results could mean for relatives.

Tests and diagnosis

Your care team

Kidney cancer care works best when specialists review your diagnosis and treatment options together and one person coordinates the plan.

Ask who your main contact is for results, side effects and urgent concerns. Save their number in your phone and share it with your caregiver.

A second opinion is reasonable, particularly before complex surgery, when the subtype is rare, or when several treatment options are equally acceptable.

How cancer is diagnosed

You are unlikely to need every possible test. The team chooses tests that answer a specific question.

1. Confirm whether there is a kidney mass and show its size, position and relationship to nearby blood vessels and organs.
2. Check your general health and kidney function through your medical history, examination, blood pressure, blood tests and urine tests.
3. Look for spread with scans of the chest and abdomen. Computed tomography (CT) combines X-rays to create detailed images. Selected questions may need positron emission tomography with CT (PET-CT), which uses a small amount of radioactive tracer to show tissue activity.
4. Obtain tissue when the diagnosis or subtype must be confirmed before treatment, or examine the tissue removed at surgery.
5. Bring the scans, tissue findings, stage, kidney function and your priorities together in a plan agreed by the specialist team.

Common blood and urine tests

• A full blood count checks red cells, white cells and platelets, which help blood clot. Creatinine is a waste product measured in blood. It helps calculate the estimated glomerular filtration rate (eGFR), an estimate of how well your kidneys filter blood.
• Liver tests and blood calcium help check your general health. Other blood tests may include alkaline phosphatase or lactate dehydrogenase, substances that can change with liver, bone or other tissue problems.
• Urinalysis is a urine test that checks for blood, protein and other changes.

These tests support diagnosis and treatment planning but cannot, by themselves, prove that a kidney mass is cancer.

Scans and staging tests

Biopsy and molecular testing

A biopsy takes small samples of tissue for examination under a microscope. A needle usually passes through the skin, guided by CT or ultrasound.

A biopsy is commonly considered when

• Imaging is uncertain or a benign condition is possible
• Planned monitoring, ablation or focused radiation is being considered
• The cancer appears advanced and drug treatment will begin without kidney surgery
• A rare subtype or a metastasis needs confirmation

Two different kinds of genetic testing

A biopsy can cause pain or bleeding, and sometimes the sample does not give a clear answer. Serious complications are uncommon. Ask how to get help if pain, dizziness, fever or blood in the urine gets worse.

Understanding your pathology report

Stage describes where the cancer is. Grade describes how abnormal the cells look and how aggressively they may behave.

A positive margin means cancer cells reach the cut edge of the removed tissue. Your team weighs the need for further treatment against its risks, using the scan and tissue findings and your kidney function. Another operation is not always needed.

Planning your treatment

Understanding your stage

TNM staging for renal cell carcinoma

Doctors combine tumour size and local growth (T), nearby lymph node involvement (N) and distant spread (M) to determine the stage. These stages apply to renal cell carcinoma (RCC), which starts in kidney tissue. Cancer of the kidney’s urine-collecting lining uses a different system.

Lymph nodes are small immune-system structures. Regional nodes are those near or draining the cancer’s starting area; distant spread means cancer has reached a site outside that regional area. Stages describe findings, not a sequence that everyone will pass through.

Purple shows cancer. The dashed outline is the kidney’s outer supporting covering, called Gerota’s fascia. Each picture shows one example of a stage; the text explains other ways that stage can occur.

Stage 1 (I)

The tumour is no larger than 7 cm and remains inside the kidney. Nearby nodes and distant sites are not involved.

Stage 2 (II)

The tumour is larger than 7 cm but remains inside the kidney, without regional nodes or distant spread.

Stage 3 (III)

Cancer reaches a major vein, the urine-collecting system, nearby fatty tissue or regional lymph nodes, but not beyond the outer supporting envelope around the kidney. There is no distant spread.

Stage 4 (IV)

Cancer grows beyond that outer envelope, including direct growth into the adrenal gland, or spreads to distant sites. Extensive nearby growth without distant metastases and metastatic cancer are different stage 4 situations.

Cancer extending along a vein is not automatically distant metastatic disease. The surgeon assesses its extent and whether an operation can remove it safely. Grade and, in metastatic disease, a separate clinical risk score help guide the plan.

Clinical stage comes from examination, biopsies and scans. Pathological stage can add information from surgery; a prefix such as yp means the tissue was assessed after treatment. A revised assessment does not necessarily mean the cancer grew while you were waiting. Grade describes the cells’ behaviour and is different from stage.

How your treatment plan is chosen

Good decisions combine medical evidence with what matters to you.

The team considers

• Stage, subtype, grade, tumour size and position
• Whether the tumour can be removed completely and safely
• Kidney function, one or two working kidneys, blood pressure and other illnesses
• Symptoms, general fitness and previous treatment
• The chance of benefit, possible harms, recovery time, cost and availability
• Your priorities, family responsibilities and comfort with monitoring or uncertainty

Shared decision-making

You and your team choose the plan together. Discuss the reasonable options, including monitoring or delaying treatment when safe. Ask how many people like you are likely to benefit, what the main side effects are and how daily life may change. A second opinion can help if you remain unsure.

Treatment recommendations change. Your oncology team should interpret current evidence for your diagnosis and treatment setting.

Your treatment options at a glance

The first major question is whether treatment needs to focus on the kidney, the whole body, or both.

Supportive and palliative care help manage symptoms and improve comfort and quality of life. They can be part of your care from the beginning, alongside treatment for the cancer.

Treatment options

Active surveillance

Active surveillance means planned monitoring with regular checks and scans. Treatment can start if the findings or your needs change.

Who may consider it

• People with a very small kidney mass, especially one under about 2 cm
• People whose age, frailty or other illnesses make treatment risk greater than the immediate cancer risk
• People with selected fluid-containing or slow-growing masses, after specialist review

What usually happens

• Initial scans, kidney-function tests and often a discussion about biopsy
• Repeat scans at defined intervals, more frequently at first
• Treatment if the mass grows, scans or symptoms change, or you prefer treatment

Monitoring can avoid or delay treatment side effects. It means attending repeat tests and living with some uncertainty. Most carefully selected small masses grow slowly, but keeping follow-up appointments is essential.

Active surveillance before treatment is different from follow-up surveillance after treatment.

Surgery: partial or radical

The aim is complete cancer removal while preserving as much safe kidney function as possible.

Approach and expertise

Surgery may use one larger cut (open surgery) or several small cuts (laparoscopic, or keyhole, surgery). In robot-assisted surgery, the surgeon controls the instruments. The choice depends on the tumour, your health and the surgeon’s experience. Smaller cuts can shorten recovery in suitable cases.

• The adrenal gland is usually removed only if imaging or the tumour position makes involvement likely.
• Nearby lymph nodes may be sampled or removed if they look suspicious. Removing many normal-looking nodes has not shown a benefit for everyone.
• A tumour in the renal vein or vena cava may require complex surgery at an experienced centre.

Ablation and focused radiation

These options can treat selected tumours without removing the kidney, particularly when surgery carries extra risk.

Important practical points

• A biopsy is usually taken before ablation to confirm the diagnosis.
• Ablation may have a higher chance of needing repeat local treatment than surgery; careful imaging follow-up is essential.
• Focused radiation can affect nearby healthy tissue. Changes after treatment can also make follow-up scans harder to interpret.
• Availability and expertise vary. Ask how many similar procedures the centre performs and how success will be checked.

Arterial embolisation blocks blood vessels feeding the tumour. It may occasionally help control bleeding or other symptoms when surgery is unsuitable.

Lowering the risk of recurrence

The pathology report helps estimate whether surgery alone is enough or whether treatment after surgery should be discussed.

Surveillance remains appropriate for many people

Regular scans and kidney-function checks are the usual approach after many stage 1 and lower-risk tumours. Your team will explain whether further treatment is likely to help.

Adjuvant treatment for selected higher-risk clear-cell RCC

Adjuvant treatment means medicine given after surgery to lower the chance of cancer returning. Pembrolizumab immunotherapy may be offered after complete removal of RCC with clear-cell features when the stage or grade shows a higher recurrence risk. Pembrolizumab alone is usually given for about one year.

Belzutifan plus pembrolizumab is another option for adults with a clear-cell component and an intermediate-high or high recurrence risk after kidney surgery, including selected people whose areas of spread have also been completely removed. Your team weighs the expected benefit against the side effects, including anaemia and low oxygen levels with belzutifan.

Traditional chemotherapy and routine radiation to the area where the kidney was removed are not standard after complete removal of typical RCC. A clinical trial, a research study testing care or treatment, may be an option.

When cancer has spread or returned

Advanced RCC is often treatable even when it cannot be removed completely. The aim is usually long-term control, symptom relief and preserving quality of life.

The plan may combine

• Systemic treatment: medicines that act throughout the body
• Focused radiation, ablation or surgery for troublesome or limited sites
• Supportive and palliative care for symptoms and treatment effects

Is kidney surgery still useful?

Cytoreductive nephrectomy means removing the kidney tumour when cancer has also spread elsewhere. Your team may discuss it if you are well enough and the kidney tumour is causing symptoms, the spread is limited, or medicines have controlled the cancer well.

Many people benefit from starting whole-body treatment first.

For metastatic RCC, doctors may use the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk score. It combines how well you manage daily activities, blood results and the time between diagnosis and starting drug treatment. It helps guide treatment but cannot predict exactly what will happen to you.

Whole-body treatment

Modern RCC treatment commonly combines medicines that activate immune cells with medicines that block cancer growth signals and blood-vessel formation.

Common first-treatment combinations for clear-cell metastatic RCC include

• Nivolumab plus ipilimumab, especially for an IMDC intermediate- or poor-risk group
• Pembrolizumab plus axitinib
• Pembrolizumab plus lenvatinib
• Nivolumab plus cabozantinib

Histology changes the plan

Non-clear-cell RCC includes several subtypes. Each may need a different treatment plan.

Non-clear-cell RCC

Papillary, chromophobe and rarer subtypes can respond differently. Treatment may use targeted medicine, immunotherapy, a combination, or chemotherapy for certain rare cancers. If the cancer is linked to an inherited condition, this may also guide the choice. Clinical trials can be particularly useful when standard treatment evidence is limited.

After the first treatment stops working

The next treatment depends on which medicines you have received, how long they worked, your symptoms and how well your organs are working. Options may include a different targeted medicine, immunotherapy if it has not already been used, treatment directed at a few growing areas, or a clinical trial.

Some later treatments depend on previous use of an immune checkpoint inhibitor targeting programmed death receptor 1 (PD-1) or programmed death-ligand 1 (PD-L1). These are proteins that help control immune responses. Your team can check whether your earlier treatment belongs to this group.

Belzutifan alone is an option for adults with advanced RCC after both a PD-1 or PD-L1 inhibitor and a VEGF-targeted TKI. Belzutifan plus lenvatinib is an option for adults with advanced RCC that has a clear-cell component after a PD-1 or PD-L1 inhibitor.

These belzutifan treatments have different eligibility requirements. Both need checks for anaemia and low oxygen levels; the combination also needs blood-pressure and other safety checks.

Your oncologist and cancer pharmacist can explain why a medicine suits your cancer, how to take it, possible interactions with other medicines, and help with access or cost.

Managing side effects

Targeted therapy side effects

TKIs are often tablets taken at home. Side effects are common but can often be managed when reported early.

Other targeted medicines have different risks: belzutifan, for example, can lower red blood cells and oxygen levels. Your team will explain which blood tests and other checks you need.

Common effects

• High blood pressure, tiredness, diarrhoea, nausea or poor appetite
• Sore mouth, taste change, rash, painful hands or feet
• Changes in thyroid function (a gland that helps control the body’s energy use), protein leaking into urine or abnormal liver tests

Your practical safety checklist

• Check blood pressure at home if advised and keep a written log.
• Report diarrhoea early. Follow your team’s advice about fluids and medicines to control it.
• Tell the oncology team before surgery, dental work or a procedure because some drugs delay wound healing.
• Share every prescription, medicine bought without a prescription, vitamin, herb and supplement. Some foods or medicines can change how a cancer drug works.
• Do not reduce, skip or restart a dose without instructions.

A planned treatment pause or dose reduction can help control side effects. The goal is a dose you can take safely and consistently.

Immunotherapy: report early

Checkpoint inhibitors can cause inflammation, an immune reaction that can harm healthy organs. Reactions may begin during treatment or weeks to months after it ends.

Possible immune-related problems

• Skin: rash, itching or blisters
• Bowel: diarrhoea, cramps or blood
• Lungs: new cough or breathlessness
• Liver: abnormal tests, yellow eyes or dark urine
• Hormone glands: severe fatigue, dizziness, headache, thirst, frequent urination or weight change
• Kidneys, heart, muscles, nerves, eyes or brain: uncommon but potentially serious inflammation

• Tell every clinician that you have received immunotherapy, even after treatment has stopped.
• Carry the treatment or immunotherapy alert card provided by your centre.
• Treatment may need to pause. Steroids, medicines that reduce inflammation, or other medicines that calm the immune system may be needed. Early care lowers the risk of permanent harm.

Live well

Supportive and palliative care

Supportive and palliative care help with physical symptoms, emotional strain and practical needs. They can be given alongside cancer treatment at any stage.

It can help with

• Pain, fatigue, appetite, nausea, constipation, sleep and breathlessness
• Anxiety, low mood, family communication, spiritual concerns and caregiver strain
• Rehabilitation, mobility, work, finances and planning ahead

When cancer affects bone or brain

Radiation, surgery or ablation may relieve pain or help protect movement and other functions. Bone-strengthening medicines may help, but your team checks kidney function and often arranges a dental assessment first.

Cancer that has spread to the brain may need steroids, surgery or precisely targeted radiation as well as whole-body treatment.

Ask for a dietitian if weight or appetite is falling, a physiotherapist for safe activity, a psychologist or counsellor for distress, and a pain or palliative specialist when symptoms remain difficult.

A caregiver also needs information, rest and support. Ask the team what tasks are essential and which can be shared.

Follow-up after treatment

Follow-up checks for cancer returning, manages effects that appear or persist after treatment, and protects your kidney and general health. The schedule is based on your own risk and needs.

A follow-up visit may include

• Symptoms, physical examination, blood pressure and medication review
• Kidney-function tests, urine protein and other blood tests when needed
• Chest and abdominal imaging at intervals based on stage, grade, subtype and treatment
• Additional tests guided by symptoms or a hereditary syndrome

If you are receiving treatment for advanced RCC

Scans and blood tests check how well treatment is working and whether it is causing harm. A small change on one scan does not always mean treatment must change. The team also considers your symptoms and how well you are tolerating treatment.

Cancer can sometimes return years later, so long-term review is important. Report new persistent pain, blood in urine, weight loss, cough, breathlessness, weakness, confusion or other new nervous-system symptoms rather than waiting for the next scan.

Anxiety before scans ('scanxiety') is common. Planning how and when results will be shared can reduce uncertainty.

Protecting a remaining kidney

Most people with one healthy kidney live normally. Ongoing care helps protect your kidney, heart and blood vessels.

• Have blood pressure, creatinine/eGFR and urine protein checked as advised.
• Avoid smoking; work towards a healthy weight, regular activity and good control of diabetes and blood pressure.
• Eat a balanced diet and limit salt. If kidney function is reduced, check with a kidney dietitian before following a high-protein diet.
• Drink enough to avoid dehydration, but follow personalised fluid advice if you have kidney or heart disease. More water is not always better.
• Ask before using painkillers such as ibuprofen or diclofenac, herbal remedies, gym supplements or high-dose vitamins. Some can harm kidney function or interact with treatment.
• Tell doctors and radiology teams that you have one kidney or reduced kidney function. Contrast scans can still be possible after an individual risk assessment.

After recovery, most exercise is helpful. If you have one kidney, discuss contact or high-impact sports with your team because an injury could affect that kidney.

Emotional and practical support

There is no correct way to feel. Shock, fear, anger, sadness, relief and uncertainty can appear together or change over time.

Related care

Explore treatments

Medical Oncology↗Cancer Surgery↗Radiation Oncology↗Cancer Diagnostics & Molecular Testing↗Supportive & Holistic Cancer Care↗

Meet our doctors

Dr (Prof) Vijay Agarwal

Professor and Lead Consultant – Medical Oncology

Dr Prathyush V

Senior Consultant – Medical Oncology & Haemato-Oncology

Dr Darshan R S

Consultant – Medical Oncology & Haemato-Oncology

Where to get care

Bannerghatta Road

Apollo Hospitals
Bengaluru

Seshadripuram

Apollo Hospitals
Bengaluru

Sarjapur

Apollo Hospitals
Bengaluru

Jayanagar

Apollo Speciality Hospital
Bengaluru