Kidney Tumours at a Glance
Usually found by chance
Most tumours are picked up on scans before they cause symptoms.
Not always cancer
Around one in five small kidney masses turns out to be benign.
Kidney-sparing first
Partial nephrectomy is preferred for most small tumours when it is technically safe.
Two different diseases
Kidney Cancer (renal cell carcinoma) and upper tract urothelial cancer are treated differently.
Symptoms and Risk Factors
Small Kidney Cancers rarely cause symptoms. When they do, the most common signs are:
- Blood in the urine, visible or on a urine test
- Persistent pain in the side or back
- A lump in the abdomen
- Unexplained fever, weight loss or anaemia
Smoking, obesity, high blood pressure and long-term dialysis increase the risk. A small number of people have inherited conditions, such as von Hippel–Lindau disease, that cause tumours in both kidneys at a younger age.
Evaluating a Kidney Mass
Contrast CT or MRI
A dedicated kidney scan shows the size of the tumour, how deeply it sits in the kidney, and its relation to the blood vessels and urine-collecting system. These details decide whether the kidney can be preserved. A chest CT completes staging.
Complex cysts
Fluid-filled cysts are very common and almost always harmless. Cysts with thick walls or solid parts are graded with the Bosniak system; only the higher grades need surgery or close follow-up.
Biopsy
A needle biopsy is not needed for everyone. It is most useful when surveillance or ablation is being considered, or when the scan raises the possibility of lymphoma or a metastasis from elsewhere.
Types of Kidney Tumour
| Type | Behaviour |
|---|
| Clear cell carcinoma | The most common Kidney Cancer, about 70–75% of cases |
| Papillary carcinoma | Second most common; often slower growing |
| Chromophobe carcinoma | Generally a favourable outlook |
| Oncocytoma | Benign |
| Angiomyolipoma | Benign; contains fat that is often visible on CT |
Treatment Options
Active surveillance
Small masses in older patients, or in those with significant health problems, can often be watched with periodic scans because many grow very slowly.
Robotic partial nephrectomy
Only the tumour is removed, with a margin of healthy tissue, and the kidney is repaired. It is the preferred option for most tumours up to 4 cm and many up to 7 cm. Preserving kidney tissue matters especially for people with diabetes, high blood pressure, existing kidney disease or a single kidney.
Radical nephrectomy
The whole kidney is removed when the tumour is large or centrally placed, or when it extends into the renal vein. Tumours that grow into the inferior vena cava need complex open or Robotic Surgery in an experienced centre.
Ablation
Small tumours can be destroyed with heat or cold through a needle in selected patients who are not suited to surgery.
Advanced Kidney Cancer
Immunotherapy combinations and targeted drugs have transformed outcomes. Treatment is chosen with medical oncology according to the IMDC risk group, and removing the kidney may still help selected patients.
Cancer of the Ureter and Renal Pelvis
Upper tract urothelial carcinoma arises from the lining of the kidney's drainage system or the ureter, the same type of lining as the bladder. It is diagnosed with CT urography and ureteroscopy, a thin telescope passed up the ureter to see and sample the tumour.
Small low-grade tumours can sometimes be treated with a laser through the ureteroscope, preserving the kidney. Higher-risk tumours are treated with robotic nephroureterectomy, removing the kidney, ureter and a small cuff of bladder. A single dose of chemotherapy into the bladder afterwards reduces the chance of a new bladder tumour, and regular cystoscopy is part of follow-up.
Recovery and Follow-Up
After robotic kidney surgery most patients walk the next day, go home in two to four days and return to desk work in two to three weeks. Heavy lifting is avoided for about six weeks. After partial nephrectomy, blood in the urine, increasing flank pain or dizziness in the first few weeks should be reported promptly.
The final pathology report gives the tumour type, grade and stage. For clear cell cancer these details estimate the risk of recurrence (Leibovich score), which sets how often CT scans are needed and whether preventive immunotherapy should be discussed. Kidney function and blood pressure are checked at each visit.
Frequently Asked Questions
Can a kidney tumour be removed without removing the kidney?
Often, yes. Many small and some moderately sized tumours can be removed by partial nephrectomy, which preserves the rest of the kidney.
Is partial nephrectomy as effective as removing the whole kidney?
For suitable tumours, long-term cancer control is comparable, and more kidney function is preserved for the future.
Can I live normally with one kidney?
Most people live a normal life with one healthy kidney. Blood pressure and kidney function should be checked regularly.
Does every kidney mass need surgery?
No. Benign tumours, simple cysts and some small slow-growing masses in older patients can be safely monitored.
Is chemotherapy used for Kidney Cancer?
Conventional chemotherapy is not effective for most Kidney Cancers. Advanced disease is treated with immunotherapy and targeted drugs.
What is the difference between Kidney Cancer and upper tract cancer?
Kidney Cancer starts in the kidney tissue itself, while upper tract cancer starts in the lining of the drainage system and ureter. They are diagnosed and treated differently.
