Newly Diagnosed With Kidney Cancer: First Steps

Kidney cancer is common, and most of it is caught early. SEER, the National Cancer Institute's cancer statistics program, lists 80,450 new cases of kidney and renal pelvis cancer in the United States for 2026, making it the seventh most common cancer. That total is a forecast the American Cancer Society produces, not something SEER has counted yet.

Here is the part that matters more on day one, drawn from people diagnosed between 2016 and 2022. SEER reports that 66% are found while still confined to the kidney. Five-year relative survival is 93.6% for those. It is 77.6% when the cancer has reached nearby lymph nodes, and 20.3% once it has spread to distant sites. Across all stages it is 79.2%.

Statistics describe groups, not you. But if you are searching at 2 a.m., that first number is the one most people have not been told yet.

Most kidney cancer in adults is renal cell cancer. NCI describes it as a disease "in which cancer cells are found in the lining of tubules (very small tubes) in the kidney," where blood is filtered and urine is made.

There is a different cancer that grows in the same organ. NCI states that "cancer that starts in the ureters or the renal pelvis... is different from renal cell cancer." That one is transitional cell cancer, and it is staged and treated by other rules.

Ask which one your report says. Everything downstream depends on the answer.

Many people are unnerved that a cancer was named without a needle. This is normal here, and NCI says so directly: "a biopsy may not be needed if the imaging test results provide enough information to make a diagnosis."

Kidney tumors have a characteristic look on contrast CT or MRI. Alongside imaging, NCI lists ultrasound, blood chemistry studies, and urinalysis in the workup, plus chest x-ray and bone scan for staging.

If you want to know why your team is confident, ask what specific imaging features made the call.

NCI's descriptions are refreshingly simple.

• Stage I. "The tumor is 7 centimeters or smaller and is found in the kidney only."
• Stage II. "The tumor is larger than 7 centimeters and is found in the kidney only."
• Stage III. Any size, with spread to nearby lymph nodes; or spread into the renal vein or vena cava, into the fat around the urine-collecting structures, or into the fatty layer around the kidney.
• Stage IV. Spread beyond that fatty layer, possibly into the adrenal gland above the kidney; or spread to bones, liver, lungs, brain, adrenal glands, or distant lymph nodes.

Seven centimeters is the number to remember. It is a little under three inches, and it separates stage I from stage II.

NCI lists three operations. Partial nephrectomy removes the cancer plus some surrounding tissue and leaves the rest of the kidney. Simple nephrectomy removes the kidney. Radical nephrectomy removes the kidney, the adrenal gland, surrounding tissue, and usually nearby lymph nodes.

NCI notes that a partial nephrectomy "may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed." It also notes that a person can live with part of one working kidney, but if both kidneys stop working, dialysis or a transplant becomes necessary.

That is the reason to ask, out loud, whether part of your kidney can be saved. Kidney function you keep now is kidney function you still have if a second tumor ever appears.

For stage I, NCI lists partial, simple, or radical nephrectomy as the main treatment.

NCI lists several alternatives. Cryotherapy freezes the tumor. Thermal ablation heats it. Stereotactic ablative body radiation therapy, a highly focused form of external radiation, may be used in some cases.

There is also arterial embolization, which NCI describes plainly: a catheter is threaded into the main blood vessel feeding the kidney, and "small pieces of a special gelatin sponge are injected through the catheter," blocking blood flow so tumor cells are starved. It is used to shrink a tumor, to relieve symptoms, and sometimes before surgery to reduce blood loss.

This is where kidney cancer care has changed the most.

For stage II, NCI lists radical nephrectomy followed by pembrolizumab, an immunotherapy, "for cancer that is at high risk of coming back." For stage III, it lists radical nephrectomy followed by pembrolizumab or sunitinib.

For stage IV, NCI's first-line list is mostly pairs: ipilimumab plus nivolumab, pembrolizumab plus axitinib, pembrolizumab plus lenvatinib, nivolumab plus cabozantinib, and avelumab plus axitinib. Single drugs including cabozantinib, sunitinib, pazopanib, sorafenib, and temsirolimus also appear, as does surgery to reduce tumor bulk in selected people.

Later lines exist too. NCI lists tivozanib for people who have already had at least two other systemic treatments.

The practical point: this is a disease where second and third options are real. Ask what the sequence looks like, not just the first drug.

Get the pathology or radiology report in your hands, not just a summary. Write down the exact tumor size in centimeters and which side. Ask which stage is assigned and whether anything is still pending. Ask whether partial nephrectomy is possible. Ask whether adjuvant immunotherapy would apply if the pathology comes back high risk.

Ask about family history too. NCI lists von Hippel-Lindau disease and hereditary papillary renal cancer among the risk factors, along with smoking, long-term misuse of certain pain medicines, excess body weight, high blood pressure, and family history of renal cell cancer. If relatives had kidney tumors, say so, because that can change screening for your whole family.

On second opinions, NCI is matter-of-fact: "you may want to get a second opinion to confirm your renal cell cancer diagnosis and treatment plan," and you will need to send your reports, slides, and scans ahead.

Signs NCI associates with renal cell cancer include blood in the urine, a lump in the abdomen, side pain that does not go away, loss of appetite, unexplained weight loss, and anemia. NCI also notes there may be no symptoms at all early on.

• Call 911 or go to an emergency department if your urine turns heavily bloody with clots and you cannot pass water, or bleeding leaves you faint, grey or sweating.
• Call your care team the same day if blood in the urine is new, or clearly heavier than before, or your flank pain has stepped up rather than simply carried on.
• Call your care team within a day or two if the lump in your side feels bigger, or appetite and weight keep dropping while you wait for your first appointment.

See also Cancer Staging, Kidney Cancer, and Getting a Second Opinion.

• https://www.cancer.gov/types/kidney/patient/kidney-treatment-pdq
• https://seer.cancer.gov/statfacts/html/kidrp.html
• https://www.cancer.org/research/cancer-facts-statistics.html