The short answer
Surgery to remove the tumor or the kidney is the main treatment for many kidney cancers. For advanced disease, targeted therapy and immunotherapy are important treatments. Some small tumors may be watched closely.
Surgery to remove the tumor or the whole kidney is the main treatment.
People can live a normal life with one healthy kidney.
Some small tumors may be watched closely (active surveillance).
Targeted therapy and immunotherapy treat advanced kidney cancer.
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The full explanation.
The simple version
Surgery is the main treatment for kidney cancer that hasn't spread far. For many people, it's the only treatment needed.
Once kidney cancer spreads more widely, treatment shifts almost entirely to drugs. These are targeted therapy and immunotherapy. Kidney cancer usually doesn't respond well to standard chemotherapy. That's unusual among solid tumors. It shapes the whole treatment approach.
Surgery
For localized kidney cancer, surgery is standard.
A partial nephrectomy removes just the tumor. It also removes a margin of nearby kidney tissue. This keeps as much healthy kidney as possible. Doctors prefer this when they can do it. It's especially useful for smaller tumors. Keeping more kidney function matters long term.
A radical nephrectomy removes the whole kidney. Sometimes it also removes nearby lymph nodes or the adrenal gland. Doctors use it when the tumor is larger. They also use it when partial removal isn't practical. Most people live a normal life with one healthy kidney. Still, kidney function afterward is worth discussing with your surgical team.
Some people aren't good candidates for surgery. Less invasive options exist for them, or for small tumors. Cryotherapy freezes the tumor. Thermal ablation heats it. Both can destroy a small tumor without removing the kidney. Active surveillance is another option. Doctors watch a small, slow-growing tumor with imaging. They treat it only if it grows.
Treatment after surgery
Some kidney cancers carry a higher risk of coming back after surgery. This risk is higher for larger tumors. It's also higher for cancer that had spread to nearby structures. For these, doctors may add pembrolizumab after surgery. It's an immunotherapy drug that lowers the chance of recurrence. A 2024 analysis, after about five years of follow-up, also found that people who took it lived longer. This has become standard care for higher-risk stage II and III disease.
Not everyone needs this after surgery. It's specifically for higher-risk situations. Ask your oncologist whether it applies to you, and why.
Advanced or metastatic disease
Once kidney cancer spreads to distant sites, treatment relies on drugs. These work very differently from standard chemotherapy. This reflects the biology of clear cell kidney cancer. That type often depends on a pathway tied to blood vessel growth.
Targeted therapies block specific signals. Cancer cells use these signals to grow and build new blood vessels. Several targeted drugs are taken as pills: sunitinib, pazopanib, sorafenib, axitinib, cabozantinib, and lenvatinib. These block VEGF, a protein that drives blood vessel growth, or related pathways. mTOR inhibitors — everolimus and temsirolimus — work through a different pathway. Doctors typically use these after other options have been tried.
Immunotherapy helps the immune system recognize and attack cancer cells. It doesn't attack the cancer directly. Checkpoint inhibitors do this work: nivolumab, pembrolizumab, and ipilimumab. Doctors use them alone or, increasingly, together.
Combinations are now standard first-line treatment for many people with advanced kidney cancer. One combo pairs two immunotherapy drugs: ipilimumab plus nivolumab. Another pairs a checkpoint inhibitor with a targeted therapy. Examples: pembrolizumab plus axitinib or lenvatinib, and nivolumab plus cabozantinib. These combinations usually work better than any single drug alone. They also carry a broader range of side effects. Your oncologist weighs this against your overall health.
Day to day
Surgery recovery usually means a hospital stay of a few days. Then come weeks of recovery at home. Targeted therapy pills are taken daily, or on a set schedule, at home. Side effects can include fatigue, high blood pressure, hand-foot skin reactions, and diarrhea. Your team monitors these. They may adjust your dose. Immunotherapy is given by infusion. This is usually every two to six weeks, depending on the drug. It carries its own side effects, tied to the immune system becoming overactive. Your team watches for this throughout treatment.
Sources
Words to know
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Common questions
What is the main treatment?
Surgery is the main treatment for many kidney cancers — removing either just the tumor (partial nephrectomy) or the whole kidney (radical nephrectomy). Most people do well with one healthy kidney.
Can small tumors be watched?
Yes. Some small kidney tumors, especially in older adults, may be watched closely with active surveillance and treated only if they grow.
How is advanced kidney cancer treated?
Advanced kidney cancer is often treated with targeted therapy and immunotherapy, which have become important and effective options.
Does chemotherapy work for kidney cancer?
Standard chemotherapy usually does not work well for kidney cancer, which is why targeted therapy and immunotherapy are the main drug treatments.
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Last updated: 2026-08-20Next planned review: 2027-07-07
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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