Kidney cancer affects 30,000 people/yr. in the U.S., and 12,000 people/yr. die from the disease, making it the most lethal of the urologic cancers.  Nowadays, it is usually found incidentally on ultrasounds or CAT scans of the abdomen ordered for other reasons.  Many kidney cancers are genetic, but there is no other well established cause of this disease.

Some small tumors of the kidney may be simply observed for a period of time.  The natural history of small tumors is often protracted.  This can be a good option for elderly or sick patients that avoids potential complications of treatment.  Biopsies of the kidney may be performed in cases where the diagnosis is in question. 

Treatment of kidney cancer is largely surgical.  The lesion can be either removed or simply ablated.  For larger lesions, removal is usually recommended.  Removal of the kidney is called a nephrectomy.  The adrenal gland and lymph nodes may also be removed (radical nephrectomy).  Often, small kidney cancers can be removed off the kidney, preserving the rest of the organ (partial nephrectomy).  All of these procedures may be performed with the traditional open incision or with laparoscopic surgery. 

Small kidney cancers can also be treated by ablative techniques.  Rather than excising the mass, a needle is inserted into the lesion, and the surgeon delivers either very high or very low temperatures to either heat or freeze the tumor.  This extreme temperature change creates scarring, effectively killing the tumor.  These techniques are done either laparoscopically or percutaneously (inserting a needle through the skin into the tumor using X-ray guidance).  This is a good choice for smaller lesions, kidneys with multiple tumors, or older/sicker patients. 

Patients with advanced or metastatic cancer may require systemic treatments in addition to surgery.  A number of new chemotherapeutic drugs have been developed in the past few years that are showing promise.  Immunotherapy is a similar treatment which has efficacy as well.  These are provided primarily by medical oncologists.