Kidney Cancer Treatment in India

Overview

A kidney cancer diagnosis can feel overwhelming, but with timely evaluation and the right treatment plan, many patients achieve excellent outcomes. Kidney cancer does not affect everyone in the same way, which is why each case requires careful assessment. The size and location of the tumour, whether it has spread, kidney function, and the patient's overall health all play an important role in deciding the most appropriate treatment.

Modern kidney cancer care has advanced significantly over the past decade. Today, treatment may include surgery, targeted therapy, immunotherapy, minimally invasive procedures, or a combination of these approaches, depending on the stage of the disease. The goal is not only to control or eliminate the cancer but also to preserve as much healthy kidney function as possible and maintain the patient's quality of life.

Successful treatment begins with an accurate diagnosis and a personalised care plan. By combining advanced medical technology with evidence-based treatment strategies and regular follow-up, healthcare specialists can provide comprehensive care at every stage of kidney cancer, helping patients make informed decisions and receive the treatment best suited to their individual needs.

What is Kidney Cancer?

Kidney cancer, also called renal cancer, develops when abnormal cells in the kidney begin to grow uncontrollably and form a tumour. The kidneys are two bean-shaped organs located on either side of the spine, just below the rib cage. They filter waste products and excess fluid from the blood, help regulate blood pressure, and produce hormones that support red blood cell production and bone health.

In most cases, kidney cancer starts in the tiny filtering tubes (renal tubules) inside the kidney. The disease usually affects one kidney, although in rare cases it can develop in both kidneys. If left untreated, the cancer may grow into nearby tissues, blood vessels, lymph nodes, or spread to distant organs such as the lungs, bones, liver, or brain.

Kidney cancer is most commonly diagnosed in adults between the ages of 50 and 70 years and is more common in men than women. Many people with early-stage kidney cancer do not experience noticeable symptoms, which is why some cases are detected during imaging tests performed for other medical conditions. When diagnosed early, kidney cancer is often highly treatable, and advances in surgery, targeted therapy, immunotherapy, and other treatments have significantly improved patient outcomes.

Understanding the disease, recognising possible symptoms, and seeking timely medical evaluation can help improve treatment success and long-term health.

Understanding the Different Types of Kidney Cancer

Kidney cancer is not a single disease. It includes several types that differ in where the cancer begins, how quickly it grows, and the treatment it requires. Identifying the exact type of kidney cancer is an important part of diagnosis, as it helps doctors choose the most effective treatment plan.

Renal Cell Carcinoma (RCC)

Renal Cell Carcinoma (RCC) is the most common type of kidney cancer in adults, accounting for about 85–90% of all cases. It develops in the tiny tubules of the kidney that filter blood and produce urine. RCC has several subtypes, including:

• Clear Cell Renal Cell Carcinoma: The most common subtype, making up around 70–75% of RCC cases. It may grow more aggressively than some other subtypes, but many patients respond well to modern treatments.
• Papillary Renal Cell Carcinoma: The second most common subtype, accounting for about 10–15% of RCC cases. It is divided into Type 1 and Type 2, which have different biological features and treatment considerations.
• Chromophobe Renal Cell Carcinoma: A less common subtype, representing around 5% of RCC cases. It usually grows more slowly and is often associated with a favourable prognosis.
• Rare RCC Subtypes: These include Collecting Duct Carcinoma, Renal Medullary Carcinoma, Translocation RCC, and a few other uncommon forms. Although rare, some of these cancers can be more aggressive and may require specialised treatment.

Urothelial Carcinoma (Transitional Cell Carcinoma)

Urothelial carcinoma develops in the renal pelvis, the area where urine collects before passing into the ureter. Although it occurs within the kidney, it behaves more like bladder cancer than Renal Cell Carcinoma. As a result, its treatment approach is different and may include surgery, chemotherapy, immunotherapy, or a combination of these treatments.

Wilms Tumour (Nephroblastoma)

Wilms tumour is the most common kidney cancer in children, especially those under five years of age. It is uncommon in adults. With early diagnosis and appropriate treatment, including surgery and chemotherapy, the survival rate is generally very good.

Renal Sarcoma

Renal sarcoma is a rare type of kidney cancer that starts in the kidney's connective or supporting tissues rather than the cells that filter blood. It accounts for less than 1% of all kidney cancers. Because it behaves differently from Renal Cell Carcinoma, treatment often involves a specialised approach that may include surgery, chemotherapy, or radiation therapy.

Note: Some kidney tumours, such as renal oncocytoma, are benign (non-cancerous). Although they may appear similar to kidney cancer on imaging scans, they do not spread to other parts of the body. Doctors use imaging tests and, in some cases, a biopsy or surgery to distinguish these benign tumours from cancer.

Understanding the Stages of Kidney Cancer

Kidney cancer is classified into different stages based on the size of the tumour, whether it has spread beyond the kidney, and whether it has reached nearby lymph nodes or other organs. Determining the stage of the cancer helps doctors choose the most appropriate treatment and estimate the likely outcome.

• Stage I: In Stage I, the tumour is 7 cm or smaller and is confined to the kidney. It has not spread to nearby lymph nodes or other parts of the body. Kidney cancer diagnosed at this stage is often highly treatable, and surgery is usually the primary treatment.
• Stage II: In Stage II, the tumour is larger than 7 cm but remains confined to the kidney. Although the cancer has grown in size, it has not spread to nearby lymph nodes or distant organs. Surgery continues to be the main treatment for most patients.
• Stage III: In Stage III, the cancer has spread beyond the kidney into nearby major blood vessels, surrounding tissues, or nearby lymph nodes, but it has not spread to distant organs. Treatment may involve surgery along with additional therapies, depending on the extent of the disease.
• Stage IV: Stage IV is the most advanced stage of kidney cancer. The cancer has spread beyond the tissue surrounding the kidney or has metastasised to distant organs, such as the lungs, bones, liver, or brain, or to distant lymph nodes. Treatment at this stage focuses on controlling the disease, relieving symptoms, improving quality of life, and, when possible, slowing or shrinking the cancer using targeted therapy, immunotherapy, surgery, or other advanced treatments.

What Causes Kidney Cancer?

The exact cause of kidney cancer is not fully understood. However, doctors know that kidney cancer develops when the DNA inside kidney cells becomes damaged or changes (mutates). These genetic changes cause the cells to grow and divide uncontrollably instead of following the body's normal growth cycle. Over time, these abnormal cells form a tumour that can grow within the kidney and, if left untreated, may spread to other parts of the body.

Several biological factors are involved in the development of kidney cancer, including:

• DNA Mutations: Most kidney cancers begin with changes in the DNA of kidney cells. These mutations disrupt the normal process that controls cell growth and repair, allowing abnormal cells to multiply and survive longer than they should.
• Changes in Tumour Suppressor Genes: The body has natural genes that help regulate cell growth and repair damaged DNA. When these tumour suppressor genes stop working properly because of genetic changes, abnormal cells can continue to grow and eventually form cancer.
• Abnormal Blood Vessel Growth (Angiogenesis): Some kidney cancers, especially clear cell renal cell carcinoma, develop changes in genes that control the formation of blood vessels. As a result, the tumour creates its own blood supply, allowing it to receive oxygen and nutrients needed for continued growth.
• Inherited Genetic Conditions: A small number of kidney cancers are linked to inherited genetic syndromes that run in families. These include Von Hippel-Lindau (VHL) disease, Hereditary Papillary Renal Cell Carcinoma (HPRCC), Birt-Hogg-Dubé syndrome, and a few other rare conditions. People with these inherited disorders have a higher risk of developing kidney cancer, often at a younger age than the general population.

It is important to note that having these genetic changes does not always mean a person will develop kidney cancer. In many cases, the disease occurs without a clear inherited cause. Lifestyle and environmental factors can also increase the risk of kidney cancer and are discussed separately as risk factors.

What Are the Symptoms of Kidney Cancer?

Kidney cancer often develops without causing noticeable symptoms in its early stages. In many people, it is discovered accidentally during an ultrasound, CT scan, or MRI performed for another medical condition. As the tumour grows, it may begin to cause symptoms. While these signs do not always mean a person has kidney cancer, they should never be ignored and should be evaluated by a doctor.

• Blood in the Urine (Haematuria): Blood in the urine is one of the most common symptoms of kidney cancer. The urine may appear pink, red, or dark brown, or the blood may only be detected during a urine test. Even if it occurs only once and disappears, it should be assessed by a healthcare professional.
• Persistent Pain in the Side or Lower Back: A constant pain or dull ache in the side (flank) or lower back that is not caused by an injury may be a sign of kidney cancer. The pain usually affects one side and may become more noticeable as the tumour grows.
• A Lump or Swelling in the Abdomen or Side: Some people may notice a lump or swelling in the abdomen, side, or lower back. This symptom is more common when the tumour becomes larger and should be examined by a doctor.
• Unexplained Weight Loss: Losing weight without changes in diet or physical activity can sometimes be a sign of kidney cancer, particularly when it occurs along with other symptoms such as fatigue or loss of appetite.
• Fatigue and Weakness: Persistent tiredness, weakness, or a lack of energy that does not improve with rest may occur in people with kidney cancer. This is often related to anaemia or the body's response to the disease.
• Fever Without Infection: An ongoing or recurring fever that is not caused by an infection may be associated with kidney cancer. If the fever continues without a clear reason, medical evaluation is recommended.
• Loss of Appetite: Some people with kidney cancer experience a reduced appetite or feel full more quickly than usual. When accompanied by unexplained weight loss, this symptom should be discussed with a doctor.
• Anaemia: Kidney cancer can sometimes reduce the number of healthy red blood cells, leading to anaemia. Symptoms may include tiredness, dizziness, pale skin, weakness, or shortness of breath.

When Should You See a Doctor?

You should seek medical advice if you notice blood in your urine, have persistent pain in your side or lower back, discover an unexplained lump, or experience ongoing fatigue, unexplained weight loss, fever, or loss of appetite. Although these symptoms can be caused by conditions other than kidney cancer, early diagnosis is important for timely treatment and better outcomes.

Kidney Cancer Risk Factors

The exact cause of kidney cancer is not always known. However, research has identified several factors that can increase a person's risk of developing the disease. Having one or more of these risk factors does not mean you will develop kidney cancer, but it may increase your chances.

• Smoking: Smoking is one of the strongest risk factors for kidney cancer. Harmful chemicals in tobacco enter the bloodstream and are filtered by the kidneys, where they can damage cells over time. The risk is higher in long-term smokers, but it begins to decrease after quitting.
• Obesity: Being overweight or obese increases the risk of kidney cancer. Excess body fat can affect hormone levels, increase inflammation, and place additional stress on the kidneys, all of which may contribute to cancer development.
• High Blood Pressure (Hypertension): People with long-term high blood pressure have a greater risk of developing kidney cancer. Although the exact reason is not fully understood, uncontrolled hypertension may damage kidney tissue over time.
• Chronic Kidney Disease and Long-Term Dialysis: People with chronic kidney disease (CKD), especially those who require long-term dialysis, have a higher risk of kidney cancer. Long-standing kidney damage and acquired cystic kidney disease may contribute to this increased risk.
• Family History and Inherited Conditions: A person is more likely to develop kidney cancer if a close family member, such as a parent or sibling, has had the disease. Certain inherited genetic conditions, including Von Hippel-Lindau (VHL) disease, Hereditary Papillary Renal Cell Carcinoma (HPRCC), and Birt-Hogg-Dubé syndrome, can also significantly increase the risk.
• Occupational Exposure to Harmful Chemicals: Long-term exposure to certain industrial chemicals, such as trichloroethylene, cadmium, and asbestos, may increase the risk of kidney cancer. People working in manufacturing, metal processing, or chemical industries should follow recommended workplace safety measures.
• Age: The risk of kidney cancer increases with age. Most cases are diagnosed in people over the age of 50, although the disease can occur in younger adults and, rarely, in children.
• Gender: Kidney cancer is more common in men than in women. Researchers believe this difference may be related to a combination of hormonal, lifestyle, and environmental factors.
• Certain Genetic Changes: Some people inherit gene mutations that increase their lifetime risk of kidney cancer. Although these inherited conditions are uncommon, individuals with a strong family history may benefit from genetic counselling and regular medical follow-up.

Important: Having one or more risk factors does not necessarily mean you will develop kidney cancer. Likewise, some people diagnosed with kidney cancer have no known risk factors. Maintaining a healthy lifestyle, avoiding tobacco, controlling blood pressure, and attending regular medical check-ups can help reduce the risk and support early detection.

How is Kidney Cancer Diagnosed?

Diagnosing kidney cancer accurately is essential for choosing the most effective treatment. If kidney cancer is suspected based on symptoms or an imaging test, doctors may recommend a combination of laboratory tests and imaging studies to confirm the diagnosis, determine the type of cancer, and find out whether it has spread to other parts of the body.

• Medical History and Physical Examination: The diagnosis usually begins with a detailed discussion about your symptoms, medical history, lifestyle habits, and family history of kidney cancer. During the physical examination, the doctor may check the abdomen and side (flank) for tenderness, swelling, or a lump, although many kidney tumours cannot be felt during a physical exam.
• Urine Tests: A urine test is commonly performed to check for blood in the urine (haematuria), which is one of the most common signs of kidney cancer. In some cases, additional urine tests may be recommended to rule out other conditions affecting the urinary tract.
• Blood Tests: Blood tests help evaluate overall health and kidney function. They can also identify abnormalities such as anaemia, high calcium levels, or changes in liver function, which may be associated with kidney cancer. Although blood tests cannot confirm kidney cancer, they provide valuable information for diagnosis and treatment planning.
• CT Scan (Computed Tomography): A contrast-enhanced CT scan is the most commonly used imaging test for diagnosing kidney cancer. It provides detailed images of the kidneys and surrounding structures, helping doctors determine the size and location of the tumour, whether nearby blood vessels or lymph nodes are involved, and if the cancer has spread.
• Magnetic Resonance Imaging (MRI): An MRI scan may be recommended when a CT scan cannot be performed or when additional detail is needed. MRI is particularly useful for evaluating the spread of the tumour into nearby blood vessels or surrounding tissues.
• Ultrasound: An ultrasound uses sound waves to create images of the kidneys. It is often the first imaging test performed when a kidney abnormality is suspected and can help distinguish between a fluid-filled cyst and a solid kidney mass.
• Kidney Biopsy: A kidney biopsy is not required for every patient. It may be recommended when imaging results are unclear or when non-surgical treatments, such as targeted therapy or immunotherapy, are being considered. During the procedure, a thin needle is used to remove a small sample of tissue, which is examined under a microscope to confirm the diagnosis and identify the type of kidney cancer.
• Additional Imaging Tests: If there is concern that the cancer has spread beyond the kidney, additional imaging tests such as a chest CT scan, bone scan, or brain MRI may be recommended based on the patient's symptoms and clinical findings. These tests help determine the stage of the cancer and guide treatment planning.

What Are the Treatment Options for Kidney Cancer?

Kidney cancer treatment is planned according to the type of cancer, its stage, the size and location of the tumour, kidney function, and the patient's overall health. No single treatment is suitable for everyone. In many cases, a team of specialists, including urologists, medical oncologists, radiation oncologists, and interventional radiologists, work together to recommend the most appropriate treatment plan.

• Surgery: Surgery is the primary treatment for most patients with kidney cancer, especially when the cancer is confined to the kidney. The aim is to remove the tumour while preserving as much healthy kidney tissue as possible.
  • Partial Nephrectomy: Also known as kidney-sparing surgery, a partial nephrectomy removes only the tumour and a small margin of healthy tissue. It is usually recommended for smaller tumours and helps preserve kidney function.
  • Radical Nephrectomy: A radical nephrectomy involves removing the entire affected kidney. It may also include nearby lymph nodes or the adrenal gland if the cancer has spread to these areas. This procedure is generally recommended for larger or more advanced tumours.
  • Robotic and Laparoscopic Surgery: Many kidney cancer surgeries can be performed using robot-assisted or laparoscopic (minimally invasive) techniques. Compared with traditional open surgery, these approaches usually involve smaller incisions, less blood loss, reduced pain, a shorter hospital stay, and faster recovery while providing similar cancer control in suitable patients.
• Targeted Therapy: Targeted therapy uses medicines that block specific proteins and pathways that help kidney cancer cells grow and form new blood vessels. It is commonly used for advanced or metastatic kidney cancer, either alone or in combination with immunotherapy.
• Immunotherapy: Immunotherapy helps the body's immune system recognise and destroy cancer cells more effectively. It has become one of the standard treatments for advanced kidney cancer and may be given alone or together with targeted therapy, depending on the type and stage of the disease.
• Ablation Therapy: For patients who are not suitable candidates for surgery, ablation therapy offers a minimally invasive alternative. These procedures are usually recommended for small kidney tumours.
  • Cryoablation: Destroys cancer cells by freezing the tumour.
  • Radiofrequency Ablation (RFA): Uses heat generated by radio waves to destroy tumour tissue.
  Both procedures are performed using imaging guidance and help minimise damage to healthy kidney tissue.
• Radiation Therapy: Radiation therapy is not usually the primary treatment for kidney cancer because the most common type, renal cell carcinoma, responds less effectively to conventional radiation. However, it can be used to relieve symptoms or treat cancer that has spread to areas such as the bones or brain. In selected cases, highly precise techniques such as Stereotactic Body Radiation Therapy (SBRT) may also be considered.
• Arterial Embolisation: Arterial embolisation is a specialised procedure that blocks the blood supply to a kidney tumour. It may be performed before surgery to reduce bleeding or to help control symptoms such as pain or bleeding in patients who are not candidates for surgery.
• Chemotherapy: Chemotherapy is not routinely used for the most common type of kidney cancer, renal cell carcinoma, because it generally does not respond well to standard chemotherapy drugs. However, chemotherapy may be recommended for certain rare types of kidney cancer, such as collecting duct carcinoma or renal medullary carcinoma.
• Active Surveillance: Not every kidney tumour requires immediate treatment. For small, slow-growing tumours, especially in older adults or people with serious medical conditions, doctors may recommend active surveillance. This approach involves regular imaging tests and follow-up visits to monitor the tumour closely. Treatment is started only if there are signs that the cancer is growing or becoming more aggressive.

Targeted Drug Therapy

Targeted drug therapy uses medicines that block specific proteins and signalling pathways that help kidney cancer cells grow, survive, and form new blood vessels. Unlike chemotherapy, which affects many rapidly dividing cells, targeted therapy is designed to act more specifically on cancer cells, helping to slow or stop tumour growth while reducing damage to healthy tissues.

Targeted therapy is commonly used to treat advanced or metastatic kidney cancer and may be given alone or in combination with immunotherapy.

Types of Targeted Therapy

• Tyrosine Kinase Inhibitors (TKIs): These medicines block proteins involved in tumour growth and the formation of new blood vessels. Commonly used drugs include sunitinib, pazopanib, axitinib, cabozantinib, and lenvatinib.
• mTOR Inhibitors: These drugs block the mTOR pathway, which plays an important role in cancer cell growth and division. Everolimus and temsirolimus are examples of mTOR inhibitors that may be recommended in selected patients.
• HIF-2α Inhibitors: For certain patients with advanced clear cell renal cell carcinoma, newer medicines such as belzutifan target the HIF-2α pathway, which is involved in tumour growth caused by VHL gene changes.

Immunotherapy

Immunotherapy helps the body's immune system recognise and destroy cancer cells more effectively. It has become one of the standard treatments for advanced kidney cancer, particularly advanced or metastatic renal cell carcinoma.

Immune Checkpoint Inhibitors

Checkpoint inhibitors block proteins such as PD-1, PD-L1, or CTLA-4, allowing immune cells to recognise and attack cancer cells more effectively.

Commonly used medicines include:

• Nivolumab
• Pembrolizumab
• Ipilimumab

Depending on the stage and type of kidney cancer, immunotherapy may be given alone or combined with targeted therapy, as combination treatment has shown improved outcomes for many patients.

Cytokine Therapy

Older immunotherapy treatments such as high-dose interleukin-2 (IL-2) and interferon-alpha are now used only in selected patients because they can cause significant side effects and have largely been replaced by modern checkpoint inhibitors.

Chemotherapy

Chemotherapy is not a standard treatment for the most common type of kidney cancer, renal cell carcinoma (RCC), because these cancer cells generally do not respond well to conventional chemotherapy drugs.

However, chemotherapy may be recommended for certain rare types of kidney cancer, such as collecting duct carcinoma or renal medullary carcinoma, where it can be an important part of treatment. The choice of chemotherapy depends on the specific subtype of kidney cancer and the patient's overall condition.

Like all cancer treatments, chemotherapy can cause side effects, including fatigue, nausea, loss of appetite, hair loss, and an increased risk of infection. Your healthcare team will monitor you closely and provide supportive care to help manage these side effects during treatment.

Kidney Cancer Complications

If kidney cancer is not diagnosed or treated in time, it can lead to complications that affect both the kidneys and other parts of the body. The risk and severity of complications depend on the size of the tumour, the stage of the disease, and whether the cancer has spread.

• Reduced Kidney Function: As the tumour grows, it can damage healthy kidney tissue and reduce the kidney's ability to filter waste and excess fluid from the blood. In advanced cases or when both kidneys are affected, this may lead to impaired kidney function or, rarely, kidney failure.
• Spread to Nearby Structures: Kidney cancer can grow into nearby tissues, major blood vessels such as the renal vein or inferior vena cava, and nearby lymph nodes. This can make treatment more complex and increase the risk of further spread.
• Metastatic Disease: Advanced kidney cancer may spread (metastasise) to other parts of the body, most commonly the lungs, bones, liver, brain, or distant lymph nodes. This can cause symptoms such as persistent cough, bone pain, fractures, neurological problems, or reduced liver function.
• Anaemia: Kidney cancer can reduce the production of healthy red blood cells or cause chronic blood loss, leading to anaemia. This may result in fatigue, weakness, dizziness, pale skin, and shortness of breath.
• High Calcium Levels (Hypercalcaemia): Some kidney cancers can increase calcium levels in the blood. This condition, known as hypercalcaemia, may cause excessive thirst, nausea, constipation, confusion, muscle weakness, or abnormal heart rhythms if left untreated.
• High Blood Pressure: The kidneys play an important role in regulating blood pressure. In some patients, kidney cancer can contribute to high blood pressure (hypertension), which may require medical treatment and regular monitoring.

Can Kidney Cancer Be Prevented?

Kidney cancer cannot always be prevented, but adopting a healthy lifestyle and managing certain medical conditions can help reduce the risk.

• Do Not Smoke: Smoking is one of the most important preventable risk factors for kidney cancer. Quitting smoking lowers the risk over time and provides many additional health benefits.
• Maintain a Healthy Weight: Being overweight or obese increases the risk of kidney cancer. Eating a balanced diet and maintaining a healthy weight can help reduce this risk.
• Stay Physically Active: Regular exercise supports overall health, helps control body weight, and may lower the risk of several cancers, including kidney cancer.
• Control Blood Pressure: Keeping blood pressure within a healthy range through lifestyle changes and prescribed medication can help protect kidney health and reduce the risk of kidney cancer.
• Protect Yourself from Harmful Chemicals: People who work with industrial chemicals, such as trichloroethylene, cadmium, or asbestos, should follow workplace safety guidelines and use appropriate protective equipment.
• Attend Regular Health Check-ups: Routine medical check-ups are especially important for people with chronic kidney disease, inherited kidney cancer syndromes, or a strong family history of kidney cancer. Early detection improves the chances of successful treatment.