Kidney cancer: diagnosis and management

For people with a renal lesion that is likely to be an oncocytoma (based on imaging, biopsy results or both), who have:

• no symptoms, then:

  • offer active surveillance

  • offer to treat the oncocytoma if they decline active surveillance

• symptoms, such as haematuria (blood in their urine), then:

  • offer to treat the oncocytoma

  • offer active surveillance if they decline treatment.
    
    See the section on active surveillance information, imaging types and scheduling.

For people undergoing active surveillance for a renal lesion that is likely to be an oncocytoma that has a growth rate greater than 5 mm in diameter in a year, discuss with the person the following options:

• having a biopsy, or a repeat biopsy, to help confirm the diagnosis (see the section on biopsy)

• treating the lesion or staying on active surveillance if the person chooses not to have a biopsy or a biopsy is not possible.

For people who choose to have a biopsy during active surveillance for a renal lesion originally suspected to be an oncocytoma that has a growth rate greater than 5 mm in diameter in a year, if the lesion is found to be:

• malignant, then move to treatment for renal cell carcinoma (RCC), following the recommendations in the section on managing localised and locally advanced RCC or managing advanced RCC

• benign, then consider:

  • continuing active surveillance or

  • treating the benign lesion.

Consider managing oncocytic renal neoplasms of low malignant potential, not otherwise specified, in the same way as an oncocytoma.

Offer active surveillance to people with Bosniak 2F cysts.

See the section on active surveillance information, imaging types scheduling.

If the Bosniak 2F cyst progresses to a Bosniak 3 or 4 cyst during active surveillance, follow the relevant recommendations in the section on managing localised and locally advanced RCC or managing advanced RCC.

Stop active surveillance and discharge the person with an oncocytoma or Bosniak 2F cyst if treatment for local symptoms, or treatment for RCC if developed in the future, is no longer an option. Explain to the person why they are being discharged from the active surveillance pathway.

Consider stopping active surveillance of an oncocytoma or Bosniak 2F cysts after 5 years and discharging the person, taking into account their preferences and clinical characteristics (such as age and fitness), if the:

• oncocytoma does not have a growth rate greater than 5 mm in diameter in any 12-month period

• Bosniak 2F cyst has not progressed to stage 3 or 4.

When discharging a person from active surveillance because their lesion has remained stable for 5 years:

• explain why they are being discharged

• explain that if they had a malignancy, it is likely that it would be detected by this time

• provide examples of symptoms that the person should contact primary care about (such as if they have blood in their urine or persistent abdominal pain).