Kidney cancer usually causes no symptoms, so doctors often discover it once a tumor is quite large. Sometimes, kidney cancer may even show up during a test for another condition. Fortunately, kidney cancer is still limited to the kidney at the time of diagnosis in most cases. That helps guide treatment. Generally, doctors base treatment options on the cancer’s stage and grade and a person’s overall health. Here is a summary of the treatment options for kidney cancer. Surgery or Tumor Destruction Surgery removes all or part of the kidney. People can survive with only one kidney, but keeping as much of the affected kidney as possible helps preserve kidney function. This may prevent the need for dialysis in the future. There are many versions of this surgery, including both open and minimally invasive procedures. In some cases, doctors may recommend destroying the tumor without removing it. This is an ablation or embolization. Surgery or tumor destruction is the main treatment for kidney cancer. It offers the best chance of cure and surviving without it is unlikely. The cancer’s stage and grade will guide the choice of procedure. If the tumor has not spread beyond the kidney, this may be the only treatment necessary. Surgery may still help people with kidney cancer that has spread. In this case, doctors usually follow it with immunotherapy. Immunotherapy Immunotherapy—or biologic therapy—uses a person’s own immune system to fight cancer. These medicines boost the immune system to help it find and kill cancer cells better. In most cases, immunotherapy comes as an IV (intravenous) medicine. Doctors most often use immunotherapy after surgery to treat kidney cancer that has spread beyond the kidney. It is also useful in people who can’t have surgery. Sometimes, it helps these people improve enough to tolerate surgery. Tumors will shrink to some degree in 20% of cases. Targeted Therapy Targeted therapies are a new area of kidney cancer treatment. These medicines work differently from standard chemotherapy drugs. They target specific markers that are only present on cancer cells. This often means fewer or less severe side effects and sometimes they work when standard chemotherapy does not. Kidney cancers are some of the most vascular—growing many new blood vessels—tumors. Giving drugs that target these new blood vessels starves the tumor. These drugs are very effective at slowing tumor growth, but are not likely to cure kidney cancer. As a result, doctors use targeted therapies for advanced kidney cancer. The goal is reducing symptoms and extending life. Radiation Radiation therapy uses high-energy waves or particles to destroy cancer. Unfortunately, kidney cancer does not respond to radiation. So it can’t treat or cure kidney cancer. Instead, doctors use it to help relieve symptoms when kidney cancer has spread to other organs and sites, such as the bones. They’ll deliver the radiation from a machine outside the body. Doctors call this external beam radiation. Chemotherapy Chemotherapy—or chemo—uses potent medicines to attack cancer cells. In general, chemotherapy is not effective in treating kidney cancer. The kidney cancer cells are very resistant to it. It is possible that it may help in a very few number of people. So doctors may still try chemotherapy if all other treatments have failed. Doctors give these medicines in cycles that last for a few weeks. Watchful Waiting Watchful waiting—or active surveillance—is close monitoring to see if the tumor is growing or changing. The goal is to avoid unnecessary treatment and allow people to maintain their quality of life. This approach may be suitable for people who have very small tumors. Doctors may recommend it for people with poor kidney function, a short life expectancy, or for those who do not want treatment. If watchful waiting causes stress, talk with your doctor about other treatment options. Making the Decision Talk with your doctor about the treatment options available for the stage and grade of your kidney cancer. Other considerations include your general health, the risk of side effects, and the possibility of cure. Consider getting a second opinion about your treatment options. Your doctor should encourage this because it can give you confidence about your treatment decision. You also may want to look into a clinical trial. Once you’ve decided on a course of action, think about where you will receive your care. Picking a hospital or treatment center is just as important as choosing the right doctor. Find out whether the best treatment for you is available locally or not. Think about whether you are willing to travel to a center of excellence for kidney cancer.