Kidney cancer stages

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on May 20, 2022.

Reprinted with permission. © 2022 American Society of Clinical Oncology. All rights reserved.

Making educated treatment decisions begins with determining the stage, or progression, of a particular disease. The stage of kidney cancer is one of the most important factors in evaluating treatment options.  

After a kidney cancer diagnosis, your 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 you and your 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.

Tests before staging

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.

Kidney cancer stages

Based on the diagnostic and staging test results, your care team determines the stage of kidney cancer. There are four basic stages:

Stage 1 kidney cancer: The cancer has not spread and is only in the kidney and isn’t larger than 7 cm.
Stage 2 kidney cancer: The cancer has not spread and is only in the kidney but is larger than 7 cm.
Stage 3 kidney cancer: The cancer may be any size, but it has spread to nearby sites outside of the kidney.
Stage 4 kidney cancer: 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.

Staging kidney cancer with the TNM system

The American Cancer Society (ACS) describes stages of kidney cancer in more detail using the American Joint Committee on Cancer’s TNM system. In this system, T stands for tumor, N for lymph nodes and M for metastasis.

  • T for tumor is T1, T2, T3 or T4.
    • A T1 tumor measures 7 cm or smaller in width.
    • A T2 tumor is larger than 7 cm.
    • A T3 tumor may be any size and has grown into a major kidney blood vessel or into the tissues on the outside of the tumor, but it hasn’t reached the adrenal gland.
    • A T4 tumor has grown into the adrenal gland.
  • N for lymph nodes is N0 or N1.
    • N0 means that cancer cells haven’t spread to any lymph nodes.
    • N1 means that cancer cells have spread to lymph nodes near the kidney.
  • M for metastasis is M0 or M1.
    • M0 means no distant spread.
    • M1 means spread to distant sites.

The ACS describes kidney cancer using the TNM system in this way:

  • Stage 1 is T1, N0, M0.
  • Stage 2 is T2, N0, M0.
  • Stage 3 is T3, N0, M0 or T1-T3, N1, M0.
  • Stage 4 is T4, any N, M0 or any T, any N, M1.

How cancer stage affects treatment

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 is recommended 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.

How stage affects kidney cancer survival rates

The stage of cancer not only helps your 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. 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 79,000 new cases of kidney cancer may be diagnosed in 2022 in the United States. Survival numbers predict that 75 percent of these people will survive at least five years. However, the stage of cancer makes a difference. If the cancer hasn’t grown outside the kidney, the five-year survival is 93 percent. For stage 4 kidney cancer, the five-year survival rate is much lower.

It’s important to know that even with more advanced cancer, the five-year survival rate is based on the past five years and doesn’t include new advances in clinical trials.

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