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 the extent of the cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.

To determine the cancer’s stage after a kidney cancer diagnosis, doctors try to answer these questions:

  • How large has the cancer grown in the kidney?
  • Has the cancer reached nearby structures, such as major blood vessels?
  • Has the cancer spread to the nearby lymph nodes or to distant organs?

The stage of kidney cancer is based on the results of the physical exam, imaging tests (CT scan, chest x-ray, PET scan, etc.), and sometimes biopsies which are described in Tests for Kidney Cancer

Understanding your kidney cancer stage

After looking at your test results, your doctor will tell you the stage of your cancer. 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 of the main (primary) tumor (T) and whether it has grown into nearby areas.
  • If the cancer has spread to nearby (regional) lymph nodes (N). Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread first.
  • If the cancer has spread (metastasized) to other organs (M). Kidney cancer can spread almost anywhere in the body, but common sites of spread are the bones, brain, and 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, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.

The earliest stage cancers are called stage 0 (carcinoma in situ), and then range from stages I (1) through IV (4). Some of the stages have sub-stages with the letters A, B, and C. The letter X means “cannot be assessed because the information is not available.”

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way. Patients with lower stage numbers tend to have a better prognosis.

The staging system in the table below uses the pathologic stage. It is based on the results of physical exam, biopsy, imaging tests, and the results of surgery. This is likely to be more accurate than clinical staging, which only considers the tests done before surgery.

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. (An explanation of the TNM system also follows the stage table below.)

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).

Explaining the TNM system

T categories for kidney cancer

TX: The primary tumor cannot be assessed (information not available).

T0: No evidence of a primary tumor.

T1: The tumor is only in the kidney and is no larger than 7 centimeters (cm), or a little less than 3 inches, across.

T1a: The tumor is 4 cm (about 1½ inches) across or smaller and is only in the kidney.

T1b: The tumor is larger than 4 cm but not larger than 7 cm across and is only in the kidney.

T2: The tumor is larger than 7 cm across but is still only in the kidney.

T2a: The tumor is more than 7 cm but not more than 10 cm (about 4 inches) across and is only in the kidney.

T2b: The tumor is more than 10 cm across and is only in the kidney.

T3: The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland (on top of the kidney) or beyond Gerota’s fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue).

T3a: The tumor is growing into the main vein leading out of the kidney (renal vein) or into fatty tissue around the kidney.

T3b: The tumor is growing into the part of the large vein leading into the heart (vena cava) that is within the abdomen.

T3c: The tumor has grown into the part of the vena cava that is within the chest or it is growing into the wall of the vena cava.

T4: The tumor has spread beyond Gerota’s fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue). The tumor may have grown into the adrenal gland (on top of the kidney).

N categories for kidney cancer

NX: Regional (nearby) lymph nodes cannot be assessed (information not available).

N0: No spread to nearby lymph nodes.

N1: Tumor has spread to nearby lymph nodes.

M categories for kidney cancer

M0: There is no spread to distant lymph nodes or other organs.

M1: Distant metastasis is present; includes spread to distant lymph nodes and/or to other organs. Kidney cancer most often spreads to the lungs, bones, liver, or brain.

Other staging and prognostic systems

The TNM staging system is useful, but some doctors have pointed out that there are factors other than the extent of the cancer that should be considered when determining prognosis and treatment.

University of California Los Angeles (UCLA) Integrated Staging System

This is a more complex system that came out in 2001. It was meant to improve upon the AJCC staging that was then in place. Along with the stage of the cancer, it takes into account a person’s overall health and the Fuhrman grade of the tumor. These factors are combined to put people into low-, intermediate-, and high-risk groups. Ask your doctor if he or she uses this system and how it might apply to you.

Survival predictors

The stage of the cancer is an important predictor of survival, but other factors are also important. For example, researchers have linked certain factors with shorter survival times in people with kidney cancer that has spread outside the kidney. These include:

  • High blood lactate dehydrogenase (LDH) level
  • High blood calcium level
  • Anemia (low red blood cell count)
  • Cancer spread to 2 or more distant sites
  • 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)

People with none of the above factors are considered to have a good prognosis; 1 or 2 factors are considered intermediate prognosis, and 3 or more of these factors are considered to have a poor prognosis and may be less likely to benefit from certain treatments.

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

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National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. V.2.2017. Accessed at: www.nccn.org on June 5, 2017.

Pili R, Kauffman E, Rodriguez R. Ch 82 - Cancer of the kidney. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier: 2014.

Last Medical Review: August 1, 2017 Last Revised: August 1, 2017

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