Kidney Cancer

What is kidney cancer?

Kidney cancer most commonly refers to renal cell carcinoma (RCC), which arises from the kidney tissue itself. There are other less common tumour types, and management depends on tumour features, staging, and individual patient factors.

A practical overview of the kidney cancer pathway in Australia

While each case is individual, most patients move through a predictable sequence:

1) Confirming what the mass is

Many kidney masses are characterised on CT or MRI. The imaging looks for features such as enhancement (how the lesion behaves with contrast), size, location, complexity, and whether there are features suggesting a benign tumour versus renal cell carcinoma.

Some masses are clearly benign on imaging. Others remain uncertain. Many are “likely cancer,” but still small and slow-growing.

2) Staging and risk assessment

If kidney cancer is likely, the next step is understanding the broader context:

• Size and location of the tumour

• Whether there is any suggestion of local spread

• Whether lymph nodes look abnormal

• Whether there are features that change urgency or the recommended treatment

Further scans may be appropriate in selected cases depending on risk features.

3) Biopsy (only when it changes management)

Unlike prostate cancer, kidney tumour biopsy is not routine for everyone. It may be useful when:

• imaging cannot confidently define the lesion,

• the result would change management (e.g., surveillance vs treatment), or

• a non-surgical option is being considered.

4) Choosing between surveillance and treatment

For many patients, especially with small tumours, the decision is not “treat or ignore.” It is choosing the right approach among:

• Active surveillance (structured monitoring)

• Surgery (partial or radical nephrectomy)

• Ablation (in selected cases)

When active surveillance is a legitimate option

A significant proportion of small renal masses grow slowly, and some never cause harm—particularly in older patients or those with competing health issues.

Active surveillance may be suitable when:

• the tumour is small and imaging suggests lower-risk features,

• the patient has significant comorbidities or higher surgical risk,

• kidney function needs to be protected, or

• the balance of benefit vs treatment risk favours monitoring.

Surveillance is not “doing nothing.” It is a structured plan that usually includes:

• interval imaging (CT/MRI/ultrasound depending on circumstances),

• monitoring tumour size and growth pattern, and

• reassessing if features change.

The aim is to identify the minority that begin to behave more aggressively, while allowing many patients to avoid treatment they may not need.

When treatment is recommended

Treatment is more strongly considered when:

• the tumour is larger, growing, or has concerning imaging features,

• there are symptoms (e.g., bleeding),

• risk features suggest higher malignant potential, or

• surveillance is no longer the safest option.

For many patients, the critical decision is which operation is best and how to preserve kidney function safely.

Partial vs radical nephrectomy: the decision that usually matters most

Partial nephrectomy (kidney-sparing surgery)

A partial nephrectomy removes the tumour and preserves the remaining kidney tissue. When oncologically appropriate, kidney-sparing surgery is often preferred because it aims to:

• preserve long-term kidney function, and

• reduce the risk of chronic kidney disease.

Whether partial nephrectomy is feasible depends on:

• tumour size, location, and complexity,

• proximity to major blood vessels/collecting system,

• baseline kidney function, and

• overall patient factors.

Radical nephrectomy (removal of the kidney)

A radical nephrectomy removes the kidney (and sometimes surrounding tissues depending on the case). It may be recommended when:

• the tumour is large or anatomically complex,

• kidney-sparing surgery would compromise cancer control or safety, or

• the affected kidney has limited function already.

This is not a “failure” of technique. In some situations, radical nephrectomy is the safest oncological operation.

Where robotic surgery fits (and what it does not change)

Robotic (keyhole) surgery is one way of performing partial or radical nephrectomy through small incisions. Across many studies comparing minimally invasive approaches (including robotic surgery) with open surgery, the minimally invasive approach is commonly associated with smaller incisions/scars, less blood loss, and shorter hospital stay on average—while other outcomes depend more on tumour biology, complexity, and patient factors than on the platform itself.

Importantly, the platform does not replace judgement. The central questions remain:

• is surveillance safe,

• is partial nephrectomy oncologically appropriate and technically safe, and

• what trade-offs are acceptable for the patient in front of us?

If you would like an overview of how robotics is used across urologic cancers (prostate, kidney and bladder), see the Robotic Urologic Cancer Surgery page.

After treatment: what follow-up usually involves

Follow-up depends on the pathology results and risk features. Some cancers require only routine surveillance imaging. Others need closer monitoring.

Your follow-up plan is typically built around:

• tumour type and grade,

• margins and staging,

• overall recurrence risk, and

• kidney function over time.