This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on May 20, 2022.
After a kidney cancer diagnosis, the patient's care team will give the cancer a stage. The stage is a measurement of how far the cancer has spread in the body. There are four basic stages of kidney cancer, and they’re given the numerals 1, 2, 3 and 4. Stage 1 is the earliest stage and stage 4 is the most advanced. This process helps the patient and his or her care team decide on the best treatment options.
Kidney cancer, also known as renal cell cancer, starts inside the kidney, where blood is filtered. Cancer that starts in the renal pelvis, where urine is collected, is technically in the kidney, but it’s a separate type of cancer called transitional cell cancer. There’s another type of cancer found in the kidney that isn’t considered renal cancer called Wilms tumor. These cancers have different stages than kidney cancer.
Many early kidney cancers are suspected after a urine sample tests positive for blood, or an imaging test of the abdomen—computed tomography (CT) scan, magnetic resonance imaging (MRI) scan or ultrasound—reveals a problem. In some cases, kidney cancer may be diagnosed with imaging tests alone.
If surgery is recommended to confirm a diagnosis, the kidney is examined by a pathologist. If surgery isn’t recommended, a long thin needle may be placed into the kidney to retrieve cells. This sample is called a needle biopsy. As an added part of staging, a chest X-ray or bone scan may be recommended to see whether kidney cancer has spread to other parts of the body.
Based on the diagnostic and staging test results, the care team determines the stage of kidney cancer.
To assess the location, size and spread of cancer, the care team will use the TNM staging system, developed by the American Joint Committee on Cancer (AJCC). TNM stands for tumor, node and metastasis, which are important factors in determining the cancer's severity. The patient's specific combination of TNM and other markers helps the care team determine the cancer's stage.
There are four basic stages of kidney cancer.
The cancer has not spread outside the kidney and isn’t larger than 7 cm. Under the TNM system, stage 1 kidney cancer is T1, N0, M0.
The cancer has not spread outside the kidney but is larger than 7 cm. Using the TNM system, stage 2 kidney cancer is T2, N0, M0.
The cancer may be any size, but it has spread to nearby sites outside of the kidney. Using the TNM system, stage 3 kidney cancer is T3, N0, M0 or T1-T3, N1, M0.
The cancer has spread away from the kidney to distant sites or organs. The most common locations kidney cancer spreads, or metastasizes, to include distant lymph nodes, the lungs, bones, liver and brain. The TNM classification for stage 4 kidney cancer is T4, any N, M0 or any T, any N, M1.
The American Cancer Society (ACS) describes stages of kidney cancer in more detail using the AJCC’s TNM system. In this system, T stands for tumor, N for lymph nodes and M for metastasis.
Once the care team gathers details about the tumor type and stage, they can evaluate the available treatment options and develop information to share with the patient about his or her prognosis. Typically, the care team takes the following factors into consideration as part of this process:
The best treatment for kidney cancer depends on the stage, along with the patient’s general health. The most common options include:
Stage 1 kidney cancer treatment: At this stage, surgery to remove the part of the kidney with the tumor may be the most appropriate choice. This surgery is called a partial nephrectomy.
Stage 2 kidney cancer treatment: At this stage, the whole kidney may be removed. This surgery is called radical nephrectomy.
Stage 3 kidney cancer treatment: Some cancers may involve a radical nephrectomy to remove the affected kidney, lymph nodes and nearby cancer cells, as well as the adrenal gland and fatty tissue.
Stage 4 kidney cancer treatment: At this advanced stage, other treatment options separate from surgery—such as targeted therapies or immunotherapy—may be recommended.
The stage of cancer not only helps the care team determine a treatment plan—it also helps predict a potential prognosis. This is done by calculating the percentage of people with kidney cancer who survive five years after diagnosis compared to people who don't have that type of cancer. It’s important to remember that this is only a statistic based on all people with kidney cancer several years in the past, so individual statistics may vary.
The ACS estimates that about 81,610 new cases of kidney cancer may be diagnosed in 2024 in the United States. Survival numbers predict that 77 percent of these people will survive at least five years compared to those who don't have kidney cancer. However, the stage of cancer makes a difference. If the cancer hasn’t grown outside the kidney, the five-year relative survival rate is 93 percent. For stage 4 kidney cancer, the five-year relative survival rate is much lower.
It’s important to know that even with more advanced cancer, the five-year relative survival rate is based on the past five years and doesn’t include new advances in clinical trials.
