What the diagnosis means
Renal cell carcinoma (most often the clear-cell type) arises in the kidney's filtering tissue; cancers of the kidney's drainage system (urothelial) are treated more like bladder cancer. Many are found incidentally on ultrasound or CT; blood in the urine, flank pain or a mass are later signs. Staging uses CT of the chest and abdomen; biopsy is not always needed before surgery.
Where medical oncology fits
- Localised disease: surgery by a urologist — removing part of the kidney (partial nephrectomy) or the whole kidney — cures most patients. Small tumours may be monitored or treated with ablation.
- After surgery for high-risk disease: a period of immunotherapy can reduce the risk of recurrence in selected patients — a decision made with medical oncology.
- Advanced or metastatic disease: medical oncology leads with immunotherapy combinations (two checkpoint inhibitors, or a checkpoint inhibitor with a targeted tablet) or targeted tablets alone, chosen by risk category, fitness and other illnesses. Removing the kidney is still sometimes helpful even when the cancer has spread, and single metastases may be treated with surgery or focused radiation.
Conventional chemotherapy is generally not effective in renal cell carcinoma, which is why it is rarely offered.
What to expect
Targeted tablets are taken daily; common effects are tiredness, high blood pressure, diarrhoea, mouth soreness and hand-foot skin reaction, managed by dose adjustment. Immunotherapy is given as infusions every 2–6 weeks; immune-related effects (thyroid, gut, skin, liver) are watched for with regular blood tests. Response is checked on scans every 2–3 months, and treatment continues while it works.
Questions to ask
- What type and stage is my kidney cancer, and is surgery curative?
- Would treatment after surgery reduce my risk of recurrence, and is it worth the side effects for me?
- For advanced disease: which combination is recommended for my risk group, and what does it cost per month?
- Is removing the kidney or treating single metastases still worthwhile?
- How will blood pressure and kidney function be monitored?
Preparing for your consultation
Bring CT/MRI reports and images, kidney function tests, the surgical pathology report if surgery is done, blood pressure history, and a medicine list.