Treatment Options

Breakdown of procedures based on clinical stage

Breakdown of procedures based on size of tumor

Partials vs. Radicals Nephrectomies

In general, treatment options are based on the stage, or spread, of the kidney cancer.  Each management option is briefly discussed here and the options are summarized in the table below.  Your kidney cancer expert will review the options for you and help decide your best course of treatment.  At Johns Hopkins our surgeons are experts on all approaches and will help tailor the treatment to the patient. One size does NOT fit all.

  • Active Surveillance: refers to periodic imaging and laboratory work to evaluate tumor size and growth.  At each visit, the physician and patient decide to continue active surveillance or undergo treatment.  Johns Hopkins has a formal program in active surveillance called the DISSRM Registry. {link to active surveillance}
  • Partial Nephrectomy: removal of the tumor and portion of the kidney that surrounds it (the margin).  Partial nephrectomy is a complex surgery and the surgeons at Johns Hopkins are amongst the busiest and most experienced kidney surgeons in the world.  This can be performed robotically or through an open incision and is typically reserved for small kidney tumors.
  • Radical Nephrectomy: removal of the entire kidney and surrounding fat.  Typically reserved for large and/or aggressive tumors that involve a large portion of the kidney or invade the lymph nodes or blood vessels around the kidney.
  • Ablative Technologies: burning or freezing of a renal mass.  Typically done percutaneously (through the skin) by interventional radiologists.  Reserved for small renal masses and patients who cannot undergo a major operation.
  • Systemic Therapy: kidney cancer does not respond to traditional anti-cancer treatments like chemotherapy or radiation.  Systemic therapies are given orally or intravenously and target the blood supply or immune-system as they relate to kidney cancer.  Systemic therapies are used for patients with advanced kidney cancers and usually administered by a medical oncologist.
 Early-stage, clinically-localized renal massesLocally advanced kidney cancersMetastatic kidney cancer
Prognosis (Cure rate) Excellent (85% or better)Good (60% or better)Fair (50% or less)
Treatment OptionsActive Surveillance
Partial Nephrectomy
Ablative Technologies
Radical Nephrectomy*
Radical NephrectomyRadical Nephrectomy
Ablative Technologies
Minimally-invasive surgeryPreferredAvailableAvailable
Systemic Therapy UsedNo Rarely Yes 
Renal Mass BiopsyUseful to determine benign from malignant massesLittle roleUseful to determine the type of kidney cancer prior to systemic therapy 

*Only when other options are not technically feasible.

I have really aggressive or advanced kidney cancer, what are my options?

This can get quite complicated and a multidisciplinary team who specialize in kidney cancer would be best to help with this.  It is important that an urologist and medical oncologist collaborate in constructing an optimal plan for your care.  Our medical oncologists are experts on the latest options.  They provide cutting edge care in a compassionate manner.  This multidisciplinary approach is most important for cancers with a high suspicion of spread!  This is because today there are NUMEROUS options and combinations for patients with advanced kidney cancer including surgery, systemic therapy and clinical trials.  

Active Surveillance

Partial Nephrectomy

Radical Nephrectomy (TOTAL KIDNEY REMOVAL)

Thermal Ablation

Nephrectomy with Vein Involvement

Targeted and Systemic Therapies