Last updated: 18-Oct-2026
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Urology Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ 4.99 from 84 Google reviews (Gota clinic) · 5.0 from 37 (Apollo, Bhat)
IN SHORT
Locally advanced means the kidney cancer has grown into the fat around the kidney, into the kidney vein or the main body vein, or into nearby nodes.
For most of these cancers the plan is still an operation. The whole kidney is removed, together with any tumour that has grown inside the vein.
After surgery, a year of immunotherapy may be offered when the risk of the cancer coming back is raised. Its benefit, side effects and cost are discussed openly.
This page is one part of a larger guide. For how kidney cancer is treated, when the kidney can be saved and how the operation is planned, start with our kidney cancer surgery guide.
Kidney cancer can grow out of the kidney in a few ways. Each one changes the plan a little. This table puts the scan words next to what they mean for you.
| The report says | What it means | What changes |
|---|---|---|
| Growth into the fat around the kidney. | The tumour has pushed past the kidney’s surface. | The whole kidney is removed with its fat covering. |
| Tumour in the kidney vein. | A finger of tumour has grown into the vein that drains the kidney. | It is removed with the kidney, by the urology cancer team. |
| Tumour in the main body vein, below the liver. | The finger has reached the large vein (IVC) that carries blood to the heart. | The vein is opened and the tumour lifted out. Extra blood is kept ready. |
| Tumour behind the liver, or up to the heart. | A high clot. It needs extra planning and a bigger team. | Heart and blood-vessel surgeons join the team. A heart-lung machine is arranged in advance. |
| Enlarged nodes near the kidney. | Cancer may have reached the lymph nodes. | The enlarged nodes are removed during surgery, to stage the cancer. |
| Growth into a nearby organ. | The tumour has gone through every layer around the kidney. | This is grouped with stage IV. Medicines lead, and the team decides if surgery helps. |
How high the tumour reaches inside the vein decides who operates, how much blood is kept ready, and whether a heart-lung machine is needed.
So the CT report must say whether there is a clot in the vein and how far up it goes. If the level is not clear, an MRI is done. A common mistake elsewhere is to open the belly before the clot has been looked for and measured. That turns a planned operation into an emergency.
Sometimes the first sign of a vein clot is outside the kidney. A new swelling of the veins above the testis, mainly on the right side, or one that does not empty when lying down, needs a kidney scan.
The operation is a radical nephrectomy. The whole kidney is removed with the fat around it. If there is tumour in the vein, the vein is opened, the tumour is lifted out, and the vein is repaired. This is never an unplanned operation.
The operation is done by keyhole or open surgery. The choice depends on the tumour size, the clot and any past surgery. The adrenal gland is removed only if the tumour reaches it. Nodes are removed when they look enlarged on the scan, to stage the cancer. Normal-looking nodes are not stripped out as a routine, because that has not been shown to help people live longer.
If a clot is found during surgery that the scans did not show, the surgeon stops, reassesses and calls for blood-vessel help. A stay in intensive care is routine after removing a clot from the main vein.
When the tumour has grown into a nearby organ, or has spread far, the plan changes. Medicines are the main treatment. Removing the kidney is offered only to selected people. They are fit, at lower risk, with little spread, or have bleeding or pain from the kidney. People at high risk are treated with medicines, not surgery. The stage and risk groups are explained on the kidney cancer stages page.
Pembrolizumab given after surgery is the only follow-on treatment shown to help people with kidney cancer live longer. It is offered when the risk of return is raised.
It suits clear cell cancer that reached the fat, the vein or the nodes, and some other high-risk results. It is given by drip every three weeks for about a year. Other drugs tried in this setting did not help, so tablet treatment is not offered after surgery.
The cost is high and rarely covered by insurance. So the benefit and the cost are discussed together, and the family decides. Eligibility for the maker’s patient support programme is checked first. Time matters here, so the cancer physician appointment is booked before you leave hospital.
| What you notice | What it may be |
|---|---|
| Loose motions that do not settle. | Inflammation of the bowel. It is not treated as a simple stomach upset. |
| Yellow eyes or dark urine. | Inflammation of the liver. |
| A new rash. | A skin reaction. |
| Great tiredness, weight change, feeling cold. | A thyroid or hormone gland problem. |
Bleeding that needs blood, a stay in intensive care, and clots in the legs or lungs are more likely when the tumour is in the vein. The risk to life is higher when the clot reaches behind the liver or the heart. These risks are explained at the consent visit.
Two things are certain, not risks. You lose about half your kidney reserve for good, and kidney checks continue for life. Avoid over-the-counter painkillers, contrast scans without advice, and unchecked herbal medicines.
This cancer needs closer checks than a small one. It can return late, sometimes after more than ten years.
| When | What is done |
|---|---|
| At four to six weeks. | Wound and histology talk. Your new kidney result is recorded as the baseline. |
| First three years. | CT of the chest and belly every three to six months. |
| Years three to five. | CT every six months. |
| After five years. | CT once a year. |
| For life. | Kidney blood test and urine protein at 3 months, 12 months, then every year. Blood pressure and sugar at each visit. |
No. It is the tumour growing along the vein. It is usually removed with the kidney in one planned operation.
The route depends on the size, the clot and past surgery. A high clot needs open surgery with a larger team.
No. It is offered when the risk of return is raised. You decide after hearing the benefit, side effects and cost.
Most people do not. The other kidney takes over much of the work. Lifelong kidney checks protect it.
This cancer can come back late, even after many years. Regular CT scans find it early, while it can still be treated.
Whether to keep or remove the kidney is explained on the kidney tumour decision page. The tests before treatment are on the kidney mass work-up page. For questions before you travel, call +91-63590-11009. Gota OPD, Gota, Ahmedabad.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Urology Cancer Surgeon
Consultation: Gota OPD, Gota, Ahmedabad. Surgery: Apollo Hospital, Bhat, Gandhinagar.
Gota OPD — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
Call: +91-63590-11009 · WhatsApp: +91-63590-11009
Has your CT or MRI report mentioned a clot or tumour in the kidney vein, or growth beyond the kidney? Send the report and the scan images on WhatsApp. The plan is made at the consultation, after the images are read and you are examined. Call +91-63590-11009 Send your scan reports on WhatsApp
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