Whilst most patients still undergo surgery to remove the kidney approximately 30% of patients present with disease that cannot be cured by surgery and alternative treatment approaches need to be found.

Kidney cancer is very resistant to conventional chemotherapy and radiotherapy so new more powerful and more targeted agents need to be developed and tested in the clinic.

This disease offers more hope than most for finding these agents as the exact nature of the genetic abnormality in the kidney cancer cells is now understood. From this knowledge better understanding of downstream processes must flow, each of which potentially offers a target for treatment. The trials of small molecule inhibitors such as sunitinib and sorafenib have established ‘proof of principle’ and now work needs to be done urgently on developing the place of these and other compounds.

Conventional surgical treatment is also changing very quickly as new powerful less-invasive techniques are developed. These offer the hope of control of the disease without the need to remove the kidney. These techniques such as radiofrequency ablation, cryotherapy, and high intensity focussed ultrasound are in their infancy but their role needs to be defined more clearly in well conducted trials. The ability to target energy to very specific areas of the body potentially allows one to destroy cancer tissue without destroying normal kidney tissue.