Kidney tumours

Tumours of the kidney may arise from the renal parenchyma or from the urothelial lining of the collecting system. They account for about 3% of all malignancies.

The most important renal parenchymal tumours are:

• renal adenocarcinoma (renal cell carcinoma):
  • 90% of all primary renal tumours
  • confined to adults
    
• nephroblastoma:
  • 3% of all primary renal tumours
  • presents in infancy or early childhood
    
• metastases:
  • most common renal tumour
  • often asymptomatic

Transitional cell carcinoma is the only important tumour of the renal pelvis. It accounts for 5% of all primary renal tumours, and often presents late. It is discussed with other urothelial tumours.

Angiomyolipoma is an important benign tumour.

NICE kidney cancer guidance covers diagnosing and managing renal cell carcinoma in people aged 18 and over. The guideline emphasizes (3):

1. renal biopsy should be used more frequently
   • offer biopsy for suspected renal cell carcinoma (RCC), especially if lesion ≤4 cm and localised.
2. biopsy helps avoid unnecessary surgery
   • confirms diagnosis before nephrectomy → reduces removal of benign lesions.
3. suggests consideration of biopsy in additional scenarios
   • larger lesions if imaging suggests benign
   • before ablative (non-surgical) treatments
   • if patient requests it
4. imaging is central to diagnosis and staging
   • CT/MRI used to characterise renal masses and assess spread (standard pathway underpinning recommendations).
5. stratify management based on stage and tumour size
   • localised vs locally advanced vs metastatic disease determines treatment approach
6. nephron-sparing surgery preferred where possible
   • partial nephrectomy is favoured over radical when feasible (preserve renal function)
7. non-surgical options should be offered in selected patients
   • e.g. ablation or active surveillance for small tumours or high-risk surgical patients.
8. ensure MDT management
   • all patients should be discussed in a multidisciplinary team for treatment planning (standard NICE cancer care principle)
9. provide specialist support and personalised care plans
   • access to clinical nurse specialists
   • individualised treatment + follow-up plans
10. assessment for hereditary kidney cancer syndromes
    • e.g. Von Hippel–Lindau (VHL)
    • offer appropriate genetic evaluation and management

For comprehensive details then see the full NICE guideline.

Reference

1. Rouprêt M et al. European Association of Urology Guidelines on Upper Urinary Tract Urothelial Carcinoma: 2023 Update. Eur Urol. 2023 Jul;84(1):49-64.
2. Escudier B et al. ESMO Guidelines Committee. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019 May 01;30(5):706-72.
3. NICE (March 2026). Kidney cancer: diagnosis and management.