# Watch small kidney tumours rather than remove them, with a national registry

Source: https://onco.cc/ideas/idea-prev-small-renal-mass-surveillance/  
OnCo record `idea-prev-small-renal-mass-surveillance` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Most kidney tumours under 3 cm found by chance grow under 0.3 cm a year, rarely spread, and a fifth are benign. Surveillance with a biopsy for grade as the default in patients over 65, with a national registry and set triggers for surgery, could spare most of these operations.

## Summary

The DISSRM registry and Canadian cohorts show growth under 0.3 cm per year and rare metastasis for small renal masses under surveillance. Propose surveillance with renal mass biopsy for grade as the default for masses under 3 cm in patients over 65, with a national registry and explicit intervention triggers.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Default surveillance cuts nephrectomy and ablation for small renal masses by at least half with a metastasis rate under 2% at five years.
- Rationale: Existing cohorts support safety, and nephron preservation improves cardiovascular outcomes.
- Proposed test: Registry with pre-specified safety monitoring plus a randomised decision-support trial.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010): https://doi.org/10.1093/jnci/djq099

## Connected records

- cancers: [Renal cell carcinoma](https://onco.cc/cancers/rcc/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [CT (computed tomography)](https://onco.cc/technologies/ct/)
- bottlenecks: [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)
- key papers: [Overdiagnosis in cancer](https://onco.cc/key-papers/paper-welch-j-natl-cancer-inst/)
- roadmaps: [Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work](https://onco.cc/roadmaps/surgery-roadmap/)

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