Active surveillance

If you have a small tumour that has not spread (stage 1), and you are elderly, or have significant medical problems, it may be safer to carefully monitor the cancer with scans and visits to see the doctor. This is called active surveillance, and it can be used for people where the risk of dying during an operation outweighs the benefits of surgery. Kidney cancers that are smaller than 3 cm are very unlikely to spread elsewhere; however, these tumours still need to be followed up in case the cancer starts to grow.

Surgery

Surgery is usually the first treatment for kidney cancer, and may be all that is required if the cancer is at an early stage. Surgery to remove kidney cancer is carried out by a specialist surgeon called a urologist.

• Radical nephrectomy – surgery to remove the entire kidney along with the primary tumour, surrounding fatty tissue, and sometimes the adrenal gland. Local lymph nodes are also removed to help determine if the cancer has spread. Radical nephrectomy can be done with a large cut (open surgery) or by keyhole surgery (laparoscopic surgery).
• Partial nephrectomy – surgery to remove only the part of the kidney containing the cancer, and sparing the remaining healthy kidney tissue. Partial nephrectomy can be done with a large cut (open surgery) or by keyhole surgery (laparoscopic surgery).
• Robot-assisted surgery – a type of laparoscopic surgery in which a special machine or robot is used by the surgeon to help carry out the surgery. The surgeon has a 3D view of the inside of your tummy and the area can be magnified 10-12 times. Robotic surgery is only available at a few specialist centres in the UK.

Ablation

For some people an operation is not possible due to their age or other serious medical problems. And some people decide against having surgery. It may still be possible to treat small, early stage kidney cancer without using surgery:

• Cryotherapy/cryoablation – a non-invasive treatment where a number of small probes are inserted through the skin (percutaneous) into the tumour, and then cooled with liquid nitrogen to freeze the cancer cells and kill them. Cryotherapy is usually carried out under general anaesthetic.
• Radiofrequency ablation (RFA) – a non-invasive treatment where heat from an electric probe inserted through the skin into the tumour is used to destroy the cancer cells. RFA is usually carried out out under general anaesthetic.

Radiotherapy

• Stereotactic radiotherapy – a type of radiotherapy that directs a high dose of radiation into the tumour, but avoids damaging surrounding tissues and organs. This is often used to treat cancer that has spread. It is particularly used for the treatment of cancer that has spread to the brain. Stereotactic body radiotherapy (SBRT) can also be used to treat metastases found in the liver, lung and pancreas, as well as the brain.