Our first guideline on kidney cancer recommends better use of biopsies to avoid surgery | National Institute for Health and Clinical Excellence (NICE)

New guidance aims to reduce variation in treatment and prevent unnecessary surgery, improving care for patients and supporting healthcare professionals.

Hundreds more people with suspected kidney cancer should have a biopsy to help confirm their diagnosis sooner and treat their disease more effectively, according to new draft guidelines from NICE.   

NICE has today launched its consultation on a new draft kidney cancer clinical guideline, which provides a comprehensive overview of the diagnosis, treatment, and care of adults with suspected or confirmed renal cell carcinoma (a type of kidney cancer). The draft guideline has been developed with clinical experts and patients. 

Just over 11,000 people in England are diagnosed with kidney cancer each year. On finding a lesion in the kidney some people undergo surgery to remove the whole kidney or a section of it. Without a biopsy, diagnosis of whether lesion was cancerous or not can only be confirmed at this time. Removal of a kidney can have a significant impact on a person’s quality of life. By carrying out a biopsy before surgery, a diagnosis can be confirmed and a decision can be made that surgery is unnecessary if the lesion poses no risk to the health of the patient.  

It is estimated that at least 600 people a year with renal lesions 4cm in diameter or smaller currently have a biopsy, a procedure where a small sample of tissue or cells is removed and tested to determine if they are cancerous. 

The recommendations in the new draft guideline could see the number of biopsies increase to around 1,200 procedures a year, thereby reducing the number of unnecessary surgeries for benign lesions and allowing healthcare professionals and patients to take a more informed approach. 

The NICE guideline recommends offering a biopsy to help confirm the diagnosis and inform treatment options for people with suspected renal cell carcinoma (RCC), where the cancer has not spread (known as localised or locally advanced), if they have a lesion on their kidney which is 4cm or smaller from which a tissue sample can be taken. 

A biopsy can also be considered for people with larger lesions where scans suggest it is benign or before they have non-surgical treatments that will destroy the lesion, or if the person requests one. 

The guidance places strong emphasis on patient information and support, recommending that all patients have access to clinical nurse specialists with kidney cancer expertise who will give them personalised care plans including details of their treatment, follow-up schedules, and clear contact information for when they need support. 

The new guideline also covers the information and support needed for people affected by kidney cancer throughout all stages of the care pathway, and recommendations for the diagnosis and management of heritable genetic conditions that significantly increase the risk of developing kidney cancer, such as Von Hippel-Lindau disease (VHL). 

This new guideline on kidney cancer represents a significant step forward in providing useful and useable information to help ensure people receive consistent, high-quality care. 

Professor Jonathan Benger, deputy chief executive and chief medical officer at NICE, 

Jonathan continued: “Our draft recommendations would likely see an increase in the number of biopsies and a reduction in the number of surgeries for benign lesions, meaning patients are spared an operation they might not need. This is not only better for the patient, but it also saves the NHS time and money that can be used to care for more people.” 

Kidney cancer is a devastating disease, and this new useful and useable draft guideline will help to ensure people receive consistent care and support at every stage of their treatment.

Professor Grant Stewart, Professor of Surgical Oncology at the University of Cambridge and topic adviser for the NICE guideline committee

NICE’s public consultation on the draft kidney cancer clinical guideline opens today and closes on Tuesday, 28 October 2025.