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Kidney Cancer Staging

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Testing for Kidney Cancer

If kidney cancer is suspected, imaging tests can often provide enough information for a surgeon to decide if surgery is needed. Once surgery is complete, the diagnosis is confirmed when the kidney, or a portion of the kidney, is evaluated by a pathologist.

Grades of Kidney Cancer

Based on the pathology report, the cancer’s grade is determined. Grades range from 1 to 4. The higher the grade, the more aggressively the cancer is growing.

  • Grades 1 and 2 look closer to normal cells and are not likely to grow quickly. This is considered a less aggressive form of kidney cancer. Active surveillance is sometimes possible for these patients.
  • Higher grades (3-4) appear very abnormal, grow quickly, and are more likely to spread. Treatment will begin right away for these patients.

Stages of Kidney Cancer

A stage is established based on several characteristics of the cancer:

  • The size of the tumor
  • Whether it has grown outside the kidney
  • Whether lymph nodes are affected
  • Whether it has spread (metastasized) to distant parts of the body

Kidney cancer staging is based on the American Joint Committee on Cancer (AJCC) TNM system, which evaluates three key factors:

T – Tumor

Describes the size of the main (primary) tumor and whether it has grown into nearby tissues.

N – Nodes

Indicates whether the cancer has spread to nearby (regional) lymph nodes.

M – Metastasis

Describes whether the cancer has spread to distant parts of the body.

The TNM Staging System

Using the TNM categories, doctors assign an overall stage from I to IV in addition to the grade. Together, this information will largely guide the treatment planning process.

  • Tumor is 7 cm or smaller and limited to the kidney
  • No lymph node involvement
  • No distant spread

In some cases, the tumors may not be large enough to surgically remove. Patients are carefully monitored for growth or symptoms, a practice called active surveillance.

  • Tumor is larger than 7 cm, but still confined to the kidney
  • No lymph node involvement
  • No distant spread

Active surveillance may still be recommended for a period of time before surgery or starting other treatments.

Cancer has begun to spread locally but not to distant organs.

This stage may include:

  • Tumor growing into a major vein (such as the renal vein or inferior vena cava)
  • Tumor growing into nearby tissues but not beyond Gerota’s fascia
  • Spread to nearby lymph node(s)
  • No distant metastasis (M0)

Treatment often includes surgery and may involve systemic therapy guided by the medical oncologist.

The most advanced stage of kidney cancer.

This stage includes:

  • Tumor that has grown beyond Gerota’s fascia
  • Spread to the adrenal gland on the same side
  • Spread to distant organs such as the lungs, bones, liver, or brain

Stage IV kidney cancer is typically treated with systemic therapies such as immunotherapy or targeted therapy, sometimes combined with surgery.

Recurrent Kidney Cancer

Recurrent cancer refers to cancer that returns after treatment. Follow-up testing, including blood tests and imaging, is used to see if cancer cells are starting to grow again. If kidney cancer appears to be growing again, it can develop locally, in the kidney area, even if the kidney was removed, in lymph nodes, or in distant organs.

The RMCC cancer care team will review all of the results and discuss the best next steps for you.

Your Courage. Our Expertise.

Understanding your stage of cancer can feel overwhelming, but you don’t have to navigate it alone. Our multidisciplinary oncology team carefully reviews your imaging, pathology, and overall health to develop a treatment plan tailored specifically to you.

If you have questions about your stage or what it means for your care, our team is here to help guide you every step of the way.

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