However, in this week's Moves in Medicine, we learn that often doesn't have to be.
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14 years ago, Seth Robinson, of Trenton, N.J., was undergoing follow up tests for chest pain when doctors found something else - kidney cancer.
Doctors at Fox Chase Cancer Center say that's a common story -
"You're working up one illness and then you find that you have a kidney tumor," says Dr. Rosalia Viterbo, a urologic oncologist.
Within days after his first diagnosis, Robinson had surgery to remove that kidney.
When small tumors were found recently on his remaining kidney, his then-doctor only offered one option.
"I have only one kidney, and you're going to take that out, and put me on dialysis? You don't know what I was going to deal with," says Robinson.
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Dr. David Chen, urologic oncology surgeon, says dialysis keeps people alive, but it's doesn't replace a kidney.
"A machine that we have has never gotten close to doing what the kidneys do," says Dr. Chen.
Instead, Dr. Chen offered Robinson a different option - kidney-sparing surgery, which only removes the cancerous parts, if possible.
"You can remove half of the kidney. Or you can remove just the tumor and salvage 90% of the kidney," says Dr. Viterbo.
Dr. Viterbo says it can often be done with robotic surgery, or laparoscopically - through small incisions.
She says the kidney-sparing approach isn't not used often enough because many doctors lack experience and expertise.
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Robinson is thrilled, because Dr. Chen was able to remove just the small tumors.
So he didn't need dialysis.
"He saved my life and my quality of life," says Robinson with a broad smile.
Doctors Chen and Viterbo say patients facing kidney cancer need a second, even a third or fourth opinion, to get all their options.
Since this cancer tends to grow slowly, there's no need to rush into a decision.