Stage 4 metastatic kidney cancer

This page was reviewed under our medical and editorial policy by

Bertram Yuh, MD, MISM, MSHCPM, Urologic Surgeon, City of Hope | Duarte

This page was updated on March 8, 2024.

Kidney cancer, also called renal cancer, is an abnormal, spreading growth that develops in the kidneys. Stage 4 kidney cancer occurs when this growth spreads beyond the kidney to the adrenal glands, lymph nodes or other organs. It’s also known as metastatic kidney cancer.

What is stage 4 kidney cancer?

Most people have two kidneys located at the back of the abdomen on either side of the spine, where the rib cage ends. The kidneys are organs that filter waste from the blood and produce urine. They are a part of the urinary tract.

When cells in the kidneys—usually in the parenchyma, the part that pulls waste from the blood—mutate, they may become cancerous. Stage 4 kidney cancer is when this mass of cancerous cells spreads beyond the layer of fatty tissue around the kidney into the adrenal glands, nearby lymph nodes or other organs.

Stage 4 renal cancer may be treatable, but it has a low survival rate. Some patients opt for palliative treatments to help reduce symptoms and lengthen life.

Where does kidney cancer spread?

Kidney cancer first spreads to the lymph nodes through the lymphatic system, the body’s drainage vessels. From there, it may spread to other organs.

The areas kidney or renal cancer may spread to when it reaches stage 4, or metastasizes, include:

  • Lungs
  • Bones
  • Liver
  • Brain
  • Adrenal glands

The disease may also spread to other organs before a person is diagnosed. Stage 4 kidney cancer tends to recur quickly, even after successful treatment.

Stage 4 kidney cancer symptoms

Metastatic kidney cancer has some specific symptoms that vary from early-stage kidney cancer symptoms. About half of people with kidney cancers may have no signs or symptoms.

Symptoms of advanced renal cancer include:

  • Fever
  • Weight loss
  • Cough
  • Large or swollen lymph nodes
  • Enlarged veins in the right side of the scrotum
  • Swelling of the legs and feet
  • Paraneoplastic syndrome (high blood pressure, high calcium levels and too many red blood cells)
  • Blood in the urine (also called hematuria)

Secondary tumors may also cause the symptoms listed below.

  • Metastatic cancer in the adrenal gland: Back or abdominal pain and digestive issues
  • Metastatic cancer in the bones: Bone pain and fractures
  • Metastatic cancer in the brain: Headaches, seizures or dizziness
  • Metastatic cancer in the liver: Jaundice or swelling in the belly
  • Metastatic cancer in the lungs: Shortness of breath

Metastatic stage 4 kidney cancer treatment

Metastatic kidney cancer may be difficult to treat. Treatment for metastatic kidney cancer may depend on the person’s age, general health and how far the cancer has spread.

Treating stage 4 kidney cancer may start with surgery to remove all or most of the mass on the kidney, the whole kidney, nearby lymph nodes and other areas where the cancer has spread. Surgery may be used to treat cancer, or it may be palliative to ease symptoms and help the patient live longer.

In some cases when the main mass in the kidney hasn’t been removed and cancer has spread to multiple areas of the body, removing the kidney doesn’t help extend the patient’s life. An alternate course of treatment may include a mix of immunotherapy and targeted therapy drugs. Targeted therapies are drugs that attack cancer cells based on specific characteristics, such as the proteins they make.

Stage 4 renal cancer treatment may also include radiation therapy instead of surgery to shrink tumors and ease symptoms. Other palliative treatments include pain medication.

Stage 4 kidney cancer life expectancy

Stage 4 kidney cancer life expectancy is measured as the percentage of people who are still alive five years after a diagnosis, compared to people who don’t have that cancer type.

Survival rates are reported as localized, which means it’s contained in the organ where it first developed; regional, where it’s spread to nearby organs or tissue; or distant, when it’s spread farther to other areas of the body.

Typically, stage 4 or metastatic cancers are classified as distant. According to the American Cancer Society, using the Surveillance, Epidemiology, and End Results (SEER) database, the five-year relative survival rate for distant kidney or renal pelvic cancer patients is 15 percent. That means compared to similar-aged people without kidney cancer, 15 percent of patients diagnosed with stage 4 kidney cancer are alive five years or more after their diagnosis.

The survival rate for metastatic kidney cancer depends on a variety of factors, including the patient’s age, overall health and the extent of the disease. Patients should always talk to their care team about their individual prognosis.

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Show references

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