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 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.

How is the kidney cancer stage determined?

The stages of kidney cancer range from I (1) through IV (4).

• The lower the number, the less the cancer has spread.
• A higher number, such as stage IV, means cancer has spread more.

Although other factors can also be important, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

The stage of a kidney cancer can be determined in 2 ways:

The clinical stage is based on the results of physical exams, imaging tests, and any biopsies that have been done (see Tests for Kidney Cancer). The clinical stage can be helpful in determining treatment options.

If surgery is done, the pathological stage (also called the surgical stage) can be determined. This is based on the information above, as well as what is learned about the cancer by examining tissue removed during the operation.

The clinical and pathological stages for kidney cancer are the same, but it’s possible that the stage might change after surgery is done. For example, surgery might show that the cancer has spread farther than what was seen on imaging tests. If this is the case, the pathological stage might be higher than the clinical stage.

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 (primary) 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.

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.

Kidney cancer stages

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

To understand these stages, it helps to know about some of the structures near the kidneys (see image below):

• Adrenal glands: Small glands that sit on top of each kidney. Like the kidneys, they are covered by Gerota’s fascia.
• Gerota’s fascia: A thin, fibrous layer of tissue that surrounds each kidney and adrenal gland.
• Renal vein: The main vein leaving the kidney, which connects it to the inferior vena cava.
• Inferior vena cava: The large vein that carries blood from the lower parts of the body back up to the heart.

 

Stage	Stage grouping	Stage description*
I	T1 N0 M0	The main tumor is no more than 7 centimeters ( 7 cm; a little less than 3 inches) across and is only in the kidney (T1). The cancer has not spread to nearby lymph nodes (N0) or distant organs (M0).
II	T2 N0 M0	The main tumor is larger than 7 cm across but is still only in the kidney (T2). The cancer has not spread to lymph nodes (N0) or distant organs (M0).
III	T3 N0 or N1 M0	The main tumor is growing into a major vein (like the renal vein or the inferior vena cava) or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota’s fascia (T3). The cancer might or might not have spread to nearby lymph nodes (N0 or N1) but it hasn't spread to distant organs (M0).
	OR
	T1 to T2 N1 M0	The main tumor can be any size, but it hasn't grown outside the kidney (T1 or T2). 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). The cancer might or might 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 for advanced kidney cancer

For stage IV (metastatic) renal cell carcinoma, factors other than the stage of the cancer can also be important.

Doctors have developed systems that use some of these factors to put people into risk groups, which can help determine a person’s prognosis (outlook) and treatment options.

The two systems that are commonly used are the Memorial Sloan Kettering Cancer Center (MSKCC) model and the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria.

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

The factors in the MSKCC system include:

• 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 factors in the IMDC system include:

• High neutrophil count
• High blood platelet cell count
• High blood calcium level
• Anemia (low red blood cell count)
• Less than a year from being diagnosed to needing 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 in the low-risk
• 1 or 2 factors are considered to be in the intermediate-risk group
• 3 or more of these factors are considered to be in the high-risk group

A person’s risk group status can be used to help decide which treatment options might be best.