Kidney Cancer Stages

After someone is diagnosed with kidney cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The stages of kidney cancer range from I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter (or number) means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is stage determined?

The staging system most often used for kidney cancer is the American Joint Committee on Cancer (AJCC) TNM system. The TNM system is based on 3 key pieces of information:

• The size and extent of the main tumor (T): How large is the tumor? Has it has grown into nearby areas?
• The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
• The spread (metastasis) to distant sites (M): Has the cancer spread to other organs such as the bones, brain, or lungs?

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. To learn more, see Cancer Staging.

The system described below is the most recent version of the AJCC system, effective as of January 2018.

Kidney cancer is typically given a clinical stage based on the results of a physical exam, biopsy, and imaging tests (described in Tests for Kidney Cancer). If surgery is done, the pathologic stage (also called the surgical stage) is determined by examining tissue removed during the operation.

Kidney cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.

Stage	Stage grouping	Stage description*
I	T1 N0 M0	The tumor is 7 cm across or smaller and is only in the kidney (T1). There is no spread to lymph nodes (N0) or distant organs (M0).
II	T2 N0 M0	The tumor is larger than 7 cm across but is still only in the kidney (T2). There is no spread to lymph nodes (N0) or distant organs (M0).
III	T3 N0 M0	The tumor is growing into a major vein (like the renal vein or the vena cava) or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota’s fascia (T3). There is no spread to lymph nodes (N0) or distant organs (M0).
	OR
	T1 to T3 N1 M0	The main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota’s fascia. The cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0).
IV	T4 Any N M0	The main tumor is growing beyond Gerota’s fascia and may be growing into the adrenal gland on top of the kidney (T4). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant lymph nodes or other organs (M0).
	OR
	Any T Any N M1	The main tumor can be any size and may have grown outside the kidney (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes and/or other organs (M1).

*The following additional categories are not listed in the table above:

• T0: There is no evidence of a primary tumor.
• NX: Nearby lymph nodes cannot be assessed due to lack of information.

Prognostic systems

The stage of the cancer is important, but other factors should be considered when determining prognosis (outcome) and treatment of people with Stage IV (metastatic) renal cell carcinoma. The two systems that are commonly used are the Memorial Sloan Kettering Cancer Center (MSKCC) criteria and the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria.

These two systems use 5 or 6 factors which, when combined, put people into low-, intermediate-, and high-risk groups.

The MSKCC system includes:

• High blood lactate dehydrogenase (LDH) level
• High blood calcium level
• Anemia (low red blood cell count)
• Less than a year from diagnosis to the need for systemic treatment (targeted therapy, immunotherapy, or chemotherapy)
• Poor performance status (a measure of how well a person can do normal daily activities)

The IMDC system includes:

• High white blood cell count (neutrophils)
• High platelet cell count
• High blood calcium level
• Anemia (low red blood cell count)
• Less than a year from diagnosis to the need for systemic treatment (targeted therapy, immunotherapy, or chemotherapy)
• Poor performance status (a measure of how well a person can do normal daily activities)

For each system, people with:

• None of the above factors are considered to be low-risk and have a good prognosis
• 1 or 2 factors are considered to be intermediate-risk and have an intermediate prognosis
• 3 or more of these factors are considered to be high-risk, have a poor prognosis, and may be less likely to benefit from certain treatments.