Medically reviewed by David B. Samadi, MD, Board-Certified Urologist and Urologic Oncologist | Last reviewed: August 2026

Kidney cancer is diagnosed in about 80,450 Americans each year, with roughly 15,160 deaths — about twice as common in men as in women, and most often diagnosed around age 65.

Two facts shape almost everything about it, and both run counter to what most people expect.

First, most kidney tumors are found by accident. More than half are discovered on a CT or ultrasound ordered for something else entirely — abdominal pain, a car accident, a routine workup. The textbook triad of blood in the urine, flank pain, and a palpable mass occurs in well under 10% of patients and generally signals advanced disease. If your tumor was found incidentally, that is genuinely good news about the stage.

Second, most patients keep their kidney. The older approach of removing the whole kidney has largely given way to nephron-sparing surgery — removing only the tumor and preserving the rest of the organ. For small tumors this is now the standard of care, not a special-case alternative, because preserving kidney function matters over a lifetime.

Dr. David Samadi is a board-certified urologist and fellowship-trained urologic oncologist practicing in Midtown Manhattan.

Request an Appointment · Call (212) 365-5000

Request an Appointment

What is kidney cancer?

Kidney cancer occurs when cells in the kidney grow abnormally and form a tumor. About 90% of cases are renal cell carcinoma (RCC), which arises from the tubules that filter blood. RCC is not a single disease — it has several subtypes that behave and respond differently:

  • Clear cell RCC — roughly 70–75% of cases, and the subtype most systemic therapies were developed against

  • Papillary RCC — about 10–15%, with type 1 and type 2 variants

  • Chromophobe RCC — about 5%, generally less aggressive

  • Rarer subtypes — collecting duct, renal medullary, translocation, and unclassified, which are uncommon but often more aggressive

Other kidney cancers include urothelial carcinoma of the renal pelvis, which behaves like bladder cancer rather than RCC and is treated accordingly, and Wilms tumor, a childhood cancer.

Incidence has risen over recent decades, largely reflecting increased imaging finding tumors that would previously have gone undetected. Mortality has fallen over the same period.

What are the symptoms of kidney cancer?

Most kidney cancers cause no symptoms at all. This is the defining feature of the disease and the reason more than half are found incidentally on imaging performed for an unrelated reason.

When symptoms do appear, they generally indicate a larger or more advanced tumor:

  • Blood in the urine — visible or microscopic

  • Persistent pain in the flank or side, below the ribs and not from injury

  • A lump or mass in the side or abdomen

  • Unexplained weight loss or loss of appetite

  • Persistent fatigue

  • Fever with no infection, often intermittent

  • Anemia, sometimes found on routine bloodwork

  • Swelling in the legs or ankles

  • New or difficult-to-control high blood pressure

Kidney cancer can also produce paraneoplastic syndromes — abnormalities in blood calcium, liver enzymes, or red blood cell counts caused by substances the tumor releases. Unexplained lab abnormalities are occasionally the first clue.

The classic combination of hematuria, flank pain, and a palpable mass appears in fewer than 10% of patients, and when it does, the disease is usually already advanced. Waiting for symptoms is not a strategy.

What causes kidney cancer?

Smoking roughly doubles the risk and accounts for a substantial share of cases. Risk declines after quitting.

Obesity is a major and rising contributor, likely through hormonal and metabolic pathways.

High blood pressure is an independent risk factor, separate from the medications used to treat it.

Chronic kidney disease and long-term dialysis substantially increase risk, particularly through acquired cystic kidney disease. Patients on long-term dialysis warrant periodic imaging surveillance.

Other established risk factors:

  • Age — most cases occur between 55 and 74; uncommon before 45

  • Sex — about twice as common in men

  • Race — more common in Black, American Indian, and Alaska Native populations

  • Family history of kidney cancer

  • Occupational exposures, including trichloroethylene and cadmium

  • Long-term heavy use of certain analgesics

Hereditary kidney cancer syndromes

About 5–8% of kidney cancers are hereditary. These include von Hippel-Lindau (VHL) disease, hereditary papillary RCC, Birt-Hogg-Dubé syndrome, hereditary leiomyomatosis and RCC (HLRCC), and succinate dehydrogenase-deficient RCC.

Genetic evaluation is worth considering if you were diagnosed young (under about 46), have tumors in both kidneys or multiple tumors in one, have a family history of kidney cancer, or have features suggesting a syndrome such as characteristic skin lesions. A hereditary diagnosis changes both your own management and screening for your relatives.

How is kidney cancer diagnosed?

Unusually among cancers, kidney cancer is often diagnosed on imaging without a biopsy. Cross-sectional imaging characterises renal masses well enough that surgery frequently proceeds on imaging findings alone.

  • CT scan with contrast — the primary tool; how a mass enhances with contrast strongly predicts whether it’s cancer

  • MRI — used when contrast is contraindicated, kidney function is impaired, or the mass is complex

  • Ultrasound — often how a mass is first spotted; distinguishes simple cysts from solid masses

  • Renal mass biopsy — increasingly used, particularly for small masses where active surveillance or ablation is being considered, or when metastatic disease or lymphoma is in the differential. Not required in every case

  • Blood and urine tests — kidney function, blood count, calcium, liver enzymes

  • Staging scans — chest imaging, and bone or brain imaging if symptoms suggest spread

Staging uses the TNM system, with tumour size a key determinant: T1a tumours are 4 cm or smaller, T1b are 4–7 cm, T2 exceed 7 cm, and T3–T4 involve growth into veins or beyond the kidney’s surrounding fascia.

How is kidney cancer treated?

Small renal masses (T1a, 4 cm or smaller)

This is the most common presentation today, and the treatment paradigm has changed considerably.

Partial nephrectomy (nephron-sparing surgery) is the standard of care. Only the tumour and a small margin are removed; the rest of the kidney stays and keeps working. Increasingly done robotically. Cancer outcomes are comparable to removing the whole kidney, while preserving kidney function — which matters, because reduced kidney function is linked to cardiovascular disease and mortality over the long term. Removing a whole kidney for a small tumour is now generally considered overtreatment.

Active surveillance is a legitimate option for selected patients — typically older patients, those with significant other medical conditions, or those with limited life expectancy. Small renal masses often grow slowly, and a meaningful proportion are benign. Surveillance means serial imaging with intervention if the tumour grows or changes. A biopsy often helps inform this decision.

Thermal ablation — cryoablation or radiofrequency ablation, usually delivered through the skin — is an option for small tumours in patients who aren’t good surgical candidates or who prefer it.

Larger and locally advanced tumours

Partial nephrectomy remains preferred where technically feasible, including for many T1b tumours.

Radical nephrectomy — removing the entire kidney — is appropriate for large tumours, tumours in a central location that can’t be safely removed partially, or those involving surrounding structures. It can be done robotically, laparoscopically, or open depending on complexity. It remains an important operation; it is simply no longer the default for every tumour.

Adjuvant therapy after surgery. For clear cell RCC at higher risk of recurrence, immunotherapy after nephrectomy improves outcomes. Adjuvant pembrolizumab has demonstrated an overall survival benefit, and in June 2026 the FDA approved belzutifan in combination with pembrolizumab for adjuvant treatment of clear cell RCC at intermediate-high or high risk of recurrence following nephrectomy, based on the LITESPARK-022 trial. If you’ve had surgery for higher-risk clear cell disease, adjuvant therapy is worth asking about specifically.

Advanced and metastatic kidney cancer

An important correction to older information: kidney cancer does not respond to conventional chemotherapy, and it is relatively resistant to radiation. For decades this made advanced RCC very difficult to treat. That has changed completely — but chemotherapy is not part of standard RCC treatment, and any source telling you otherwise is out of date.

Immunotherapy combinations are now first-line. Standard options pair two checkpoint inhibitors (ipilimumab plus nivolumab) or a checkpoint inhibitor with a targeted agent (pembrolizumab with axitinib or lenvatinib, nivolumab with cabozantinib). Choice depends on risk category, disease burden, and your other health conditions.

Targeted therapies — including cabozantinib, axitinib, lenvatinib, pazopanib, and sunitinib — block the blood vessel growth pathways RCC depends on. Used in combination first-line and as later-line options.

Belzutifan, a HIF-2α inhibitor, is approved for advanced RCC after prior therapy and for VHL-associated tumours, representing a genuinely distinct mechanism.

Cytoreductive nephrectomy — removing the primary tumour in the presence of metastatic disease — is still used in selected patients, though its role has narrowed as systemic therapy has improved.

Metastasis-directed treatment, including surgery or stereotactic radiation to a limited number of metastases, can be valuable in oligometastatic disease. Radiation, while not curative for the primary tumour, is useful for symptom control, particularly bone and brain metastases.

Clinical trials matter especially here. RCC treatment has changed more in the last decade than almost any other cancer, and much of what is now standard was trial-only a few years ago.

Kidney cancer survival rates

Stage at diagnosis 5-year relative survival
Localized (confined to the kidney) ~93%
Regional (spread to nearby structures or nodes) ~75%
Distant (spread to distant organs) ~18%
All stages combined ~78%

These reflect patients diagnosed several years ago. That caveat matters more in kidney cancer than almost anywhere else: outcomes in advanced disease have improved substantially since the immunotherapy combinations entered practice, and current figures likely understate what’s achievable today.

Why choose Dr. Samadi

  • Board-certified urologist and fellowship-trained urologic oncologist

  • Kidney preservation as the starting point — evaluating every renal mass for nephron-sparing surgery rather than defaulting to removing the kidney

  • Robotic surgical expertise for partial and radical nephrectomy

  • Second opinions welcome, particularly for patients told they need their whole kidney removed for a small tumour

  • Midtown Manhattan office at 485 Madison Avenue, convenient to Grand Central

We accept most major insurance plans; our team will verify your coverage before your visit.

Schedule a consultation

If a scan has found a kidney mass, or you’ve been told you need your kidney removed, a specialist evaluation — including whether the kidney can be preserved — is worth having.

Request an Appointment

Office: 485 Madison Avenue, 21st Floor, New York, NY 10022 Phone: (212) 365-5000 Hours: [insert hours]

Sources

  • American Cancer Society. Cancer Facts & Figures 2026; Key Statistics About Kidney Cancer; Survival Rates for Kidney Cancer.

  • Campbell SC, et al. Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline.

  • Choueiri TK, et al. Adjuvant Pembrolizumab plus Belzutifan for Renal-Cell Carcinoma (LITESPARK-022). New England Journal of Medicine, 2026.

  • Choueiri TK, et al. Overall Survival with Adjuvant Pembrolizumab in Renal-Cell Carcinoma (KEYNOTE-564). New England Journal of Medicine, 2024.

  • U.S. Food and Drug Administration. Approval of belzutifan with pembrolizumab for adjuvant treatment of renal cell carcinoma, June 12, 2026.

  • National Cancer Institute. Renal Cell Cancer Treatment (PDQ®); SEER Cancer Stat Facts: Kidney and Renal Pelvis Cancer.

This page provides general medical information and is not a substitute for individualized medical advice. Discuss your diagnosis and treatment options with a qualified physician.

Frequently Asked Questions

Can I live with only one kidney?

Yes — one healthy kidney can maintain normal function. But this is no longer a reason to remove a whole kidney unnecessarily. Preserving kidney tissue lowers the long-term risk of chronic kidney disease and its cardiovascular consequences, which is why partial nephrectomy is preferred whenever it’s feasible.

My scan found a kidney mass — is it cancer?

Not necessarily. Many renal masses are simple cysts or benign tumours such as angiomyolipomas or oncocytomas. How the mass appears and enhances on CT or MRI usually clarifies this, and a biopsy can help when it doesn’t.

Do I need a biopsy before kidney surgery?

Often not. Imaging characterises renal masses well enough that surgery frequently proceeds without one. Biopsy is most useful when considering active surveillance or ablation, when the imaging is ambiguous, or when metastatic disease or lymphoma is possible.

Does kidney cancer respond to chemotherapy?

No — renal cell carcinoma is notably resistant to conventional chemotherapy, and this is a common misconception. Modern treatment for advanced disease uses immunotherapy and targeted therapy instead, which have transformed outcomes over the past decade.

Is robotic kidney surgery better than open surgery?

Robotic and laparoscopic approaches generally mean smaller incisions, less blood loss, and faster recovery. The right approach depends on tumour size, location, and complexity — some tumours are better addressed openly. Surgeon experience with the specific approach matters more than the technology.

How often will I need scans after treatment?

Follow-up imaging is typically every 3 to 12 months initially, spacing out over several years, with the schedule based on your stage, grade, and surgery type. Kidney cancer can recur late, so surveillance often continues for five years or longer.

Can kidney cancer be screened for?

There’s no routine screening for the general population. Screening is recommended for people with hereditary syndromes such as VHL, and imaging surveillance is reasonable for patients on long-term dialysis. For everyone else, most kidney cancers are found incidentally.

Is kidney cancer hereditary?

About 5–8% of cases are. Genetic evaluation is worth considering if you were diagnosed before about age 46, have multiple or bilateral tumours, or have a family history. A hereditary diagnosis affects your own care and your relatives’ screening.