Newly diagnosed with kidney cancer: what happens next
The type of cancer, its stage and grade, the tests you'll have, and the treatment options your team will discuss with you, explained the way I explain them in clinic.
In this article
Most people I meet with kidney cancer weren't expecting it. The tumour was found on a scan done for something else: back pain, a stomach problem, a routine check. One week life is normal, and the next you're trying to absorb words like "renal mass" and "nephrectomy".
If that's where you are now, this article is for you. It won't replace the conversation with your own team, but it should help you follow that conversation, and show you what the next few weeks usually look like.
The first thing to know
The word "cancer" often sounds worse than the diagnosis really is. Because so many kidney cancers are now found by chance, they are often found early, when they are small and still contained within the kidney. Many grow slowly. Most can be removed, and a large number are cured.
You also have two kidneys, and a lot of my work is about removing the tumour while keeping as much healthy kidney as possible. None of this makes the diagnosis trivial. But I'd like you to know from the start that most people in your position are dealing with something serious and very treatable at the same time.
Your first few weeks
The path from diagnosis to treatment is well established. Every hospital does things slightly differently, but it usually looks like this:
- The scan that found itUsually a CT scan, sometimes an ultrasound. You'll be referred urgently to a urology team.
- Staging testsA CT scan of your chest and abdomen if you haven't had one, and blood tests to check your kidney function.
- Specialist team reviewYour scans are discussed at a multidisciplinary team (MDT) meeting of urologists, radiologists, oncologists, pathologists and specialist nurses.
- Your consultationYou'll meet a consultant to talk through the results and your options. You'll usually be introduced to a clinical nurse specialist, who becomes your main point of contact.
- Treatment or monitoringOnce you've decided together, a date is set. In the NHS, treatment should normally start within 62 days of an urgent referral.
- Follow-upRegular scans afterwards, tailored to the type and stage of your cancer.
What type of kidney cancer is it?
Your kidneys are two bean-shaped organs that filter your blood and make urine. Around nine in ten kidney cancers start in the tiny tubes inside the kidney that do the filtering. These are called renal cell carcinomas, or RCC.
- Clear cell RCC is the most common type, around three-quarters of cases. It's named after how the cells look under the microscope.
- Papillary RCC and chromophobe RCC are less common. Chromophobe cancers in particular tend to behave less aggressively.
A different, rarer cancer can start in the lining of the kidney's drainage system rather than the filtering tissue. It behaves more like bladder cancer and is treated differently. So one of the first useful questions is simply: what type is this? Sometimes the answer only becomes certain after a biopsy or after surgery.
Worth knowing: not every kidney lump is cancer. Around one in five small solid kidney tumours turn out to be benign. And most cysts are harmless. My article on kidney cysts vs kidney tumours explains the difference.
Stage and grade: two words you'll hear a lot
These are easy to mix up, but they measure different things.
Stage
Where is the cancer?How big the tumour is and whether it has spread beyond the kidney. It usually comes from your scans, and is confirmed after surgery.
Grade
How might it behave?How abnormal the cells look under the microscope, from 1 (closest to normal, slow-growing) to 4 (most abnormal, more likely to spread). It comes from a biopsy or the removed tumour.
Doctors describe the tumour itself with a "T" category, based on its size and whether it has grown into the vein or the tissues around the kidney:
The T category is then combined with whether lymph nodes are involved and whether the cancer has spread elsewhere, to give an overall stage from 1 to 4:
I go through the T categories in more detail in kidney cancer staging explained. The simplest way I put it to patients is this: stage tells you where the cancer is today, and grade hints at how it might behave in the future. Together, they guide your treatment and how closely you're followed up afterwards.
The tests that shape your options
- CT scan: most kidney cancers are first seen on CT. A CT of your chest as well as your abdomen is a standard part of staging, to check the lungs.
- MRI scan: sometimes used if the CT isn't clear, if you can't have the contrast dye used in CT, or to look more closely at whether a vein is involved.
- Blood and urine tests: to check how well your kidneys are working, which matters a great deal when choosing treatment.
- Bone scan: only if you have symptoms such as bone pain, or your blood tests suggest it is needed.
Not everyone needs a biopsy. If the scan appearance is typical and surgery is planned, a biopsy often adds little and won't change the plan, because the whole tumour will be examined afterwards. But a biopsy can be very useful if the tumour is small and you're considering monitoring or ablation, or if there's a real chance it isn't cancer at all. It is taken with a fine needle under local anaesthetic, guided by ultrasound or CT. Ask your team which situation applies to you.
Stage tells you where the cancer is today. Grade hints at how it might behave in the future.
Your treatment options
There is no single correct route. These are the options your team will weigh up, and why.
Active surveillance
Regular scans, every few months at first, without treatment for now. It's a sensible choice for some small tumours, particularly for people who are older or have other health problems, because many small kidney tumours grow very slowly. Surveillance means keeping a close eye. If the tumour grows, treatment is still available.
Surgery
When the cancer is contained within the kidney, surgery offers the best chance of cure. The aim is to remove all of the cancer while protecting as much kidney function as possible, because your long-term kidney health matters for the rest of your life.
- Partial nephrectomy removes the tumour with a thin rim of healthy tissue and keeps the rest of the kidney. It's the preferred operation for smaller tumours where it's technically possible. Can a kidney tumour be removed without losing the kidney?
- Radical nephrectomy removes the whole kidney. It's used when the tumour is large or in a position where kidney-sparing surgery isn't safe. Most people live normally with one healthy kidney.
Both are now routinely done with keyhole robotic surgery, which means smaller cuts, less pain and a faster recovery for most people. Whether a tumour can be removed while keeping the kidney depends a lot on its size and position. My article on what a high RENAL score means explains how surgeons judge this, and recovery week by week describes what to expect afterwards.
For some people with a higher risk of the cancer returning after surgery, a year of immunotherapy afterwards may be recommended to lower that risk. Your oncologist would discuss this with you once the tumour has been examined.
Ablation
For some small tumours, a needle is passed through the skin into the tumour to destroy it by freezing (cryoablation) or heating. There's no surgical cut, and recovery takes days rather than weeks, though a second treatment is needed more often than after surgery. I compare the two in cryoablation or partial nephrectomy?
If the cancer has spread
If the cancer has spread beyond the kidney, the focus shifts to controlling it, usually with immunotherapy or targeted drug treatments given by an oncologist. In selected cases, surgery to remove the kidney or individual areas of spread is also part of the plan. Treatment for advanced kidney cancer has improved enormously over the last decade, and many people now live well for years.
Kidney cancer in my practice
I am the NHS Kidney Cancer Lead for South West London at St George's, and robotic kidney surgery is the core of my work. From my audited robotic series:
Audited robotic series to the end of 2025. Trifecta: clear margins, no major complications and warm ischaemia under 25 minutes. See all outcomes
What to do in the meantime
The waiting is often the hardest part. A few things my patients find help:
- Take one step at a time. The next step is usually a single scan or a single appointment. That's all you need to hold in your mind.
- Bring someone with you to appointments. Two people remember far more than one, and you can ask whether it's alright to record the conversation.
- Write your questions down the night before.
- Be careful with the internet. Much of what you'll find describes cancers very different from yours. The charities below are reliable places to start.
- Look after yourself. Keep active, eat well, and if you smoke, now is a very good time to stop. It helps your recovery from any treatment.
Feeling shaken, distracted or tearful is normal. It doesn't mean things are worse than you've been told.
Questions worth writing down
Screenshot or print this list and take it with you. A good team will welcome every one of these questions.
- What type of kidney cancer is it, and what stage and grade?
- Has my case been discussed at the specialist MDT meeting?
- Do I need a biopsy, and would it change the plan?
- What is my kidney function now, and how would each option affect it?
- Is active surveillance a sensible option for me, and what would make it unsafe?
- Can the tumour be removed while keeping the rest of the kidney?
- How many of these operations does my surgeon perform, and what are their results?
- Who is my clinical nurse specialist, and how do I contact them?
- What happens if the first treatment doesn't work?
You don't have to take it all in at once
A kidney cancer diagnosis comes with a lot of information in a short time. Nobody expects you to understand all of it after the first appointment. Ask questions, ask them again, and take the time you need to feel comfortable with the plan. That is what your team is there for.
