With increasing health awareness and newer imaging equipment, a higher percentage of patients with small renal tumors are being detected during physical examinations. Small renal tumors are generally defined as substantial kidney masses with a maximum diameter of ≤4 cm, which can also be referred to as incidental tumors. There are more treatment options for small renal tumors. Therefore, patients are often overwhelmed when they consult several specialists to choose these treatment options. Here is a summary of common questions about small renal tumors. Question 1: Are small kidney tumors always malignant? Answer: Most small kidney tumors are asymptomatic at the time of discovery, but according to the increasingly advanced CT or MRI technology and the experience of imaging doctors and urologists, they can be basically judged as benign or malignant. However, there are about 10-20% of small kidney tumors that are considered malignant before surgery and the pathological findings are benign after resection. Question 2: What is the best treatment option for small kidney tumors? Answer: Kidney-conserving surgery, which is to remove the tumor and a little normal kidney tissue around the tumor, preserving most of the kidney tissue and maintaining the kidney function. Question 3: Can all small kidney tumors undergo kidney-conserving surgery? Answer: It should be decided according to the location of the tumor in the kidney. It is mainly the adjacent relationship with the large blood vessels in the kidney to determine whether kidney-preserving surgery can be performed. Of course, it is also directly related to the level and experience of the surgeon. Question 4: Should I choose open kidney preservation surgery or laparoscopic kidney preservation surgery? Answer: Renal preservation surgery is one of the largest surgeries in urology. Whether open, or minimally invasive laparoscopic kidney-preserving surgery, it requires a high level and sufficient experience of the surgeon. There is no difference between open and minimally invasive surgery in terms of effectiveness in treating tumors and protecting kidney function. Question 5: Are there any other treatments for small kidney tumors? Answer: There are also radiofrequency or cryotherapy for small kidney tumors internationally. However, kidney preservation surgery is still the most reliable method to treat small kidney cancer. At present, a few hospitals in China have carried out radiofrequency treatment for kidney tumors, but the treatment effect is yet to be confirmed by large clinical trials. Question 6: Can small kidney tumors be treated without surgery? Answer: For patients who are not physically fit for surgery and may have serious comorbidities with high risk of surgery, they can be reviewed regularly.