Why kidney cancer doesn’t always need treatment

Dr. Cadeddu looks over patient scans.
Imaging is an important part of active monitoring for cancer.

About 80 percent of the patients I see for kidney cancer are diagnosed while they are being treated for an unrelated reason. A patient may have a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan after a car accident, injury, or for another condition, and their doctor notices a growth on their kidney. A little more than half of these are stage 1 tumors, meaning the tumors are small, early-stage, and aren’t causing any symptoms. Generally speaking, these types of tumors aren’t a short-term threat to patients. They are slow-growing, and their risk of spreading at this stage is incredibly low.

When a patient is diagnosed with kidney cancer in this early stage, we often don’t need to treat it right away. In fact, many older patients don’t need to be treated at all. Instead, many of my patients choose an option called active monitoring for their kidney cancer as opposed to surgery or other treatments.

What is active monitoring of kidney cancer?

Active monitoring of kidney cancer is a plan to routinely check on a kidney tumor. Patients in our active monitoring program generally come in twice a year for checkups and imaging studies to make sure their tumors aren’t growing or spreading.

Most people who are diagnosed with kidney cancer are in their 60s or 70s. I tell my patients, if you’re in your 70s and have an early stage 1 kidney tumor, it’s much more likely (up to five times in some studies) that you will die of something other than kidney cancer over the next five years. Thus, most people in their 70s or 80s with stage 1 kidney cancer will die with it, not of it. Heart attacks, strokes, and many other medical conditions that are fairly common among older patients are more likely to be fatal than a kidney tumor that is in this early stage.

Active monitoring often is a safe, effective option for older patients who have multiple medical conditions. Patients who aren’t in the best of health are good candidates for active monitoring because we can possibly spare them from surgery or other treatments.

Related reading: An overview of kidney cancer 

When we treat early-stage kidney cancer

For young, otherwise healthy patients, we’re more likely to recommend treatment than active monitoring. These patients’ cancers are more likely to eventually develop into a more serious problem without treatment.

Age is one of the main factors that help us determine whether a patient with early-stage kidney cancer needs treatment. But we may recommend treatment for older patients who have a family history of long lifespans. I’ve seen some patients in their mid-70s who have parents in their 90s. In cases like these, we’re more likely to recommend treatment because their kidney cancer may have time to develop into a more advanced case.

Even if patients and their doctors decide treatment is best, there usually isn’t a need to have treatment immediately. Because of the slow-moving, slow-growing nature of kidney cancer, there’s a much lower short-term risk to the patient than there may be with other cancers. I recommend my patients arrange time off work to start treatment so it is more convenient and less stressful for them.

We use minimally invasive robotic surgery for most patients who need kidney cancer treatment. This often involves removing just the cancerous part of the patient’s kidney, which is called a partial nephrectomy. In some cases, we may need to remove the entire kidney, which is called a radical nephrectomy. Learn more about our kidney cancer treatment options.

Early detection of kidney cancer usually leads to the best outcomes. When we find it early in the disease process, there usually isn’t an urgent need for treatment. Regular checkups as part of our active monitoring program are enough for most patients. And for patients who do need treatment, we’ll help you decide on the best course of action to increase your chances of a healthy life after kidney cancer.

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