Kidney cancer care has changed: what a new BMJ review says about diagnosis and treatment
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Renal cell carcinoma, diagnosed in 435 000 people a year worldwide, is now treated with options that range from kidney-sparing surgery to immunotherapy combinations, according to a review published Oct. 26, 2026, in The BMJ. Kidney cancer care has changed quickly.
Renal cell carcinoma is the most common form of kidney cancer. Many cases are now found by chance, on scans done for other reasons. The review summarizes how diagnosis and treatment have changed.
How is it diagnosed?
Beyond looking at the tumor under the microscope, doctors now also classify renal cell carcinoma by its molecular subtype, which helps predict how it will behave. Diagnosis relies on cross-sectional imaging, a CT scan or an MRI, and on biopsy in selected cases.
How is early kidney cancer treated?
| Situation | Approach described in the review |
|---|---|
| Localized tumor | Removing the kidney, or nephrectomy, remains standard |
| Smaller tumors | Partial nephrectomy, which removes only the tumor and keeps the rest of the kidney |
| Selected patients | Ablation, which destroys the tumor with heat or cold, or targeted radiation |
| High-risk clear cell type after surgery | Pembrolizumab, which improves disease-free and overall survival |
And when it has spread?
In metastatic disease, combinations based on immune checkpoint inhibitors, drugs that release the brakes on the immune system, have extended overall survival, with lasting responses in some patients.
What are the remaining challenges?
Some tumors don’t respond to immunotherapy from the start, and others stop responding over time. There are also no reliable biomarkers yet to predict who will benefit from each treatment or how the disease will evolve.
Why does this matter for kidney cancer?
Kidney cancer care has moved toward keeping as much kidney as possible when the tumor is small and toward immune-based combinations when it has spread. Knowing the options helps patients ask the right questions.
How solid is this evidence?
It’s moderate as a source. Mongevity rates it C on our A-to-E scale: a narrative review by experts that summarizes trials and guidelines, not a new study or a formal meta-analysis. The individual treatments it describes are backed by randomized trials.
What does this mean for you?
If a scan finds a kidney mass, ask whether it can be treated while keeping part of the kidney, and whether you should be seen at a center with experience in kidney cancer. Not smoking, keeping a healthy weight and controlling blood pressure are known ways to lower risk.
How do I explain this at dinner?
Kidney cancer is often found by accident on a scan. Today, small tumors can often be removed while saving most of the kidney, and when the cancer spreads, drugs that wake up the immune system have helped people live longer. A good question for the table: why might finding a cancer by accident be good news?
In one sentence: a new BMJ review shows kidney cancer care has moved toward kidney-sparing surgery and immunotherapy combinations, though resistance and lack of biomarkers remain challenges.
Questions and answers
- What is renal cell carcinoma?
- The most common form of kidney cancer, diagnosed in 435 000 people a year worldwide.
- Can part of the kidney be saved?
- Yes: partial nephrectomy is an option for smaller tumors.
- What is new for advanced kidney cancer?
- Combinations based on immune checkpoint inhibitors have extended overall survival.