Kidney cancer happens when cells in the kidney begin to grow and divide out of control. It ranks in the top 10 types of cancer that affect both men and women in the United States, according to the American Cancer Society (ACS).

Ablation and surgery are two treatment options for kidney cancer. Ablation destroys tumor cells, while surgery aims to remove the tumor from the body.

Below, we’ll discuss the differences between these two types of treatment. Then, we’ll cover what each procedure is like and answer some additional questions.

• can treat tumors in situations where surgery may be risky due to underlying medical conditions
• can be repeated if needed
• preserves function of the affected kidney
• lower chance of risks like bleeding
• outpatient procedure
• faster recovery time
• only recommended for smaller tumors
• tumors can recur
• may have lower overall survival compared with surgery
• can potentially cure a cancer
• can be used for larger tumors
• provides more complete pathology results, since the removed tumor is available for review
• partial nephrectomy preserves some kidney function
• minimally invasive surgical options are available
• requires hospital admission
• longer recovery time
• more risks
• advanced cancers may still progress

Overall, surgery is the preferred treatment for kidney cancer. However, renal mass ablation may be used when surgery isn’t an option. This ablation targets just the cancer cells.

Let’s explore each of these treatment options in more detail.

Renal mass ablation

Renal mass ablation involves destroying the tumor cells within the kidney. This is typically done using either extreme cold or high heat:

  • Cryotherapy. This destroys tumor cells using extreme cold.
  • Radiofrequency ablation (RFA). This uses heat from high energy radio waves to destroy tumor cells.

Ablation is typically used for small kidney tumors. The ACS says these tumors are no larger than about 1 1/2 inches, or 4 centimeters.

Your doctor may recommend this treatment if other underlying health problems prevent you from having surgery or if you choose not to have surgery.

Kidney surgery

Kidney surgery involves surgically removing the tumor from the body. Two types of surgery are used for kidney cancer:

  • Partial nephrectomy. This removes the tumor and some of the surrounding kidney tissue.
  • Radical nephrectomy. This removes the entire kidney and often the adrenal gland, nearby lymph nodes, and surrounding fatty tissue.

Like ablation, partial nephrectomy is often used to remove small tumors, although it may be used in some situations to remove larger tumors as well. In this type of surgery, you’ll retain most of the function in the affected kidney.

Most people can function well with just one kidney after a radical nephrectomy. This type of surgery may be recommended if:

  • The tumor is large.
  • There are multiple tumors in the affected kidney.
  • The tumor cannot be removed with partial nephrectomy due to its location.
  • The cancer has spread beyond the kidney.

While surgeons can perform both partial and radical nephrectomy as open surgeries, they now often do them using minimally invasive procedures. These include laparoscopic and robot-assisted laparoscopic procedures.

Before the procedure

Before a kidney ablation, you’ll get instructions from your doctor on when to stop eating and drinking. Your doctor will also review any medications, supplements, or herbal remedies you use, and let you know if you need to stop taking them or adjust their dosage before the procedure.

During the procedure

The National Health Service (NHS) says an ablation procedure is short, typically taking 60 to 90 minutes. People undergoing renal mass ablations typically go home on the same day. You’ll only need to stay overnight in the hospital if you experience complications from the procedure.

Kidney ablation can be done in two different ways:

  • Cryotherapy. For this procedure, a needle is passed into the tumor either through the skin or by using laparoscopy. Extremely cold gas is passed into the needle, which destroys the tumor cells.
  • RFA. In RFA, a thin probe is placed into the tumor through the skin. An electric current is then passed through the tip of the probe, generating high heat. This heat then destroys the tumor cells.

In both procedures, imaging helps guide the placement of the needle or probe. This may include ultrasound, CT scan, or MRI scan.

When cryotherapy or RFA happen through the skin, they’re known as percutaneous procedures. For percutaneous procedures, local anesthesia will be used, which numbs the area where the needle or probe is inserted.

After your procedure

The NHS says you may be able to return to your daily activities within a few days of your ablation procedure. Your doctor will let you know if there are any specific things that you should avoid doing as you recover.

Serious risks of ablation are rare. Some potential risks may include things like:

  • post-ablation syndrome, a temporary flu-like illness
  • bleeding
  • infection
  • damage to the kidneys, ureters, or other nearby tissues

Outlook for kidney ablation

A 2019 study of 112 tumors treated with RFA found that there were 10 cancer recurrences. In individuals with at least 10 years of follow-up, cancer-specific survival was 94 percent and overall survival was 49 percent.

A 2018 study found that, while 5-year overall survival for those receiving ablation was shorter than for those receiving partial nephrectomy, cancer-specific survival for both treatments was similar. A second 2018 study echoes these findings.

A 2019 study found that overall survival and cancer-specific survival were better with partial nephrectomy when tumors were between 2 and 4 centimeters. However, for tumors smaller than 2 centimeters, cancer-specific survival was similar between ablation and partial nephrectomy.

Before the procedure

Similar to with ablation, your surgeon will give you specific instructions regarding fasting and taking medications, supplements, and herbal remedies before your kidney surgery. Be sure to follow their instructions carefully.

During the procedure

A nephrectomy typically takes between 2 and 3 hours, according to the NHS. You’ll also need to stay in the hospital for several days before you’re able to go home. If you experience surgical complications — such as a reaction to the anesthesia, excessive bleeding, blood clots, or infections — your hospital stay may be longer.

During kidney surgery, the surgeon may make one large incision, which is known as an open procedure. Or, they could make several smaller incisions, which is a minimally invasive procedure. They’ll then remove either part of the kidney or the entire kidney.

Kidney surgery is done using general anesthesia. You’ll be asleep during the procedure and will wake up in a recovery room after it has ended.

After your procedure

A 2018 study estimates it can take 6 to 12 weeks to fully recover from a nephrectomy. As with ablation, your doctor will give you instructions on what to do to help your recovery go as smoothly as possible.

While risks are generally more common with nephrectomy than with ablation, serious risks are still rather rare. Some of the potential risks of kidney surgery include:

  • reactions to the anesthesia
  • excess bleeding
  • infection
  • serious blood clots
  • urine leaking into the abdomen during partial nephrectomy
  • damage to nearby organs and tissues
  • kidney failure

Outlook for kidney surgery

A 2015 study included 802 people who had a nephrectomy for locally advanced kidney cancer. Most of the participants had a radical nephrectomy.

Cancer progressed in 189 people, with 104 dying from it. Factors associated with a better outlook were:

  • being in good overall health
  • having no symptoms at presentation
  • having cancer that had not yet spread to the lymph nodes

A 2018 study found that overall and cancer-specific survival were similar between partial nephrectomy and radical nephrectomy. A 2020 study also found no difference in overall and cancer-specific survival between open and minimally invasive nephrectomy.

When making decisions on a treatment plan for your kidney cancer, have an open discussion with your doctor. During this time, it’s important to review all of your treatment options and ask any questions that come to mind.

When it comes to deciding between ablation and surgery, some questions that you may want to ask include:

  • Based off of my individual situation, which treatment would you recommend? Why?
  • For ablation, would cryotherapy or RFA be used? Why?
  • For surgery, would you be using an open procedure or a minimally invasive procedure? Why?
  • What would recovery be like after ablation compared with surgery?
  • What are the potential risks associated with ablation and surgery? Is one associated with more serious risks than the other?
  • Will I need more treatment after either ablation or surgery? If so, what will it involve?
  • Is my cancer more likely to come back after one type of treatment than the other?
  • Are both of these treatments covered under my insurance?

Remember that your doctor and care team are there to help you. Because of this, don’t hesitate to raise any additional questions or concerns that may come to mind.

Now let’s wrap up by answering some more quick questions about ablation and surgery for kidney cancer.

Which procedure is done more often?

Surgery is done more often. A 2019 analysis of individuals with small kidney tumors between the years of 2002 and 2015 found that:

  • 80 percent received a nephrectomy.
  • 12 percent had ablation.
  • 8 percent were managed with active surveillance.

How soon should I do either procedure?

If your cancer is large, is growing quickly, or has already spread to other tissues, your doctor will recommend that you start treatment as soon as you can. Which type of treatment they’ll recommend depends on your individual situation.

Sometimes, your doctor will recommend monitoring a tumor with imaging every 3 to 6 months without treating it, according to the ACS. If it shows signs of growth, treatment can begin.

This is called active surveillance. It’s often recommended for small, slow-growing tumors or for people in poor overall health who may not respond well to ablation or surgery.

Will I need to have surgery if the ablation doesn’t work?

If your cancer comes back after ablation, your doctor may recommend surgery. However, it’s also possible that they’ll use a second ablation to treat the cancer.

Will I need additional treatments?

Additional treatment after surgery is called adjuvant therapy. Adjuvant therapy is not generally used after a partial nephrectomy or ablation, since these masses are small and have a low risk of coming back and spreading. Adjuvant therapy is usually reserved for people with large or aggressive masses to prevent possible recurrence or spread.

For example, if you’re at risk of your cancer returning after surgery, you may receive additional treatment with targeted therapy drugs or immunotherapy drugs. These drugs are meant to help prevent the cancer from coming back or spreading.

What other treatment options are there for kidney cancer?

In addition to ablation and surgery, there are also other treatment options for kidney cancer, such as:

Which treatment your doctor will recommend depends on things like the type of kidney cancer you have, its stage, your age, and your overall health.

Surgery is the preferred option for treating kidney cancer. In some cases, it can actually cure the cancer. Surgery for kidney cancer can involve the removal of all or part of a kidney.

Ablation may be used in people with smaller tumors who cannot have surgery or do not want to have surgery. It involves destroying tumor cells with extreme cold or high heat.

Be sure to have an open conversation with your doctor when deciding on how to approach your treatment. They can let you know the different benefits and risks associated with each type of treatment.