We generally refer to substantial renal tumors with a maximum diameter of ≤4 cm as small renal tumors. With the improvement of people’s health awareness and the popularization of imaging equipment, we find that the proportion of such patients among kidney tumor patients is increasing. At present, there are more treatment methods for small renal tumors. Therefore, it is often a scenario that patients and their families see several specialists, but the specialists may propose different treatment plans. How to choose is often troubling for patients and their families. Here is a summary of common questions about small renal tumors. Question 1: Are small kidney tumors always malignant? Answer: Not necessarily, about 10-20% of small kidney tumors may be benign. Question 2: What is the best treatment option for small kidney tumors? Answer: Renal conserving surgery. Not radical nephrectomy. Question 3: Can all small kidney tumors be treated with kidney-conserving surgery? Answer: No. The location of the tumor and the relationship with the large blood vessels in the kidney portal are the important basis for determining whether kidney-conserving surgery can be performed, followed by the patient’s physical condition, willingness, and the level and experience of the surgeon, which are also directly related to whether kidney-conserving surgery can be performed. Usually, tumors located in the upper and lower pole of kidney and exophytic tumors (more than 60% of the tumor volume is located outside the contour of kidney) can be operated. Question 4: Should I choose open or laparoscopic kidney-preserving surgery? Answer: Both open and laparoscopic kidney-preserving surgery need doctors with rich experience, and both methods are the same in terms of tumor treatment effect and protection of kidney function. However, the recovery of patients after laparoscopic kidney preservation surgery may be faster and the postoperative incision is more beautiful. However, the technical requirements of doctors are higher and doctors should have rich experience. Question 5: Are there any other treatments for small kidney tumors? Answer: At present, there are radiofrequency or cryotherapy for kidney cancer internationally. But they cannot replace the status of kidney-conserving surgery as the gold standard for treating small kidney cancer at present. But it is possible in the future. At present, radiofrequency or cryotherapy can be used for patients of advanced age or with serious comorbidities and other patients who are not suitable for surgical treatment. In addition, the smaller the tumor is under 3 cm, the better the effect of radiofrequency treatment. We have routinely carried out radiofrequency treatment here, and from the current information, the effect is positive. Question 6: Can small kidney tumors be treated without surgery? Answer: At present, it is internationally considered that for those with short life expectancy and high risk of surgery for serious comorbidities, active wait-and-see (Active surveillance) can be considered. This method requires regular follow-up.