The Four Stages of Renal Cell (Kidney) Carcinoma

by Rachel Zohn Health Writer

What do you need to know about staging and renal cell carcinoma (RCC), the most common type of kidney cancer? First, staging helps doctors determine where the cancer is located, if it has spread, and what treatment options are best suited for your situation. Second, staging usually begins with diagnostic tests — physical exams, for example, or imaging tests like magnetic resonance imaging (MRI), computed tomography scan (CT scans), or ultrasounds, which can help doctors learn the extent of your cancer.

Cancer cells.

Kidney cancer may be localized, regional, or metastatic

Doctors use four stages — 1 through 4, with 4 being the most severe — to describe the progression and severity of cancer. (See information on “stage 0” in sides 5 and 6.) RCC, specifically, may also be described as localized (found only in the kidney), regional (the cancer has spread to tissues around the kidney and nearby lymph nodes), and metastatic (it has spread to other parts of the body).

Doctor showing kidney diagram on a tablet.

How kidney cancer begins

Kidney cancer begins when cells in the organ begin to grow out of control, causing a mass or tumor, which disrupts and crowds out normal cells. As cancer spreads beyond the kidney, it invades other organs or lymph nodes. Surgery is commonly used at all stages of kidney cancer, but doctors may also recommend other non-surgical treatments, such as medicines, radiation therapy, or chemotherapy.

Doctor discussing treatment with a patient.

Understanding the 'TNM' staging system

Using the results of diagnostic tests, doctors rely on a tool called the TNM staging system to describe what stage the cancer is in. TNM stands for Tumor, which describes the size of the primary tumor and determines if it has grown to other areas; Node, which indicates if the tumor spread to the lymph nodes and if so, where and how many; and Metastasis, which refers to if and where the cancer has spread, or metastasized, to other parts of the body.

Diagram of kidneys and bladder.

Understanding stage 0, before cancer has spread

Sometimes kidney cancer is caught at "stage 0," before it has spread into the surrounding tissue. This type of kidney cancer is usually transitional cell cancer of the renal pelvis and ureter. This is when cancer cells form in the renal pelvis, which is the top part of the ureter, or duct that carries urine from the kidney to the bladder.

Kidney tissue.

Treating carcinoma 'in situ'

Stage 0 is known as carcinoma in situ, or found “in place,” meaning it hasn’t started to spread to nearby tissues. Kidney cancer caught at this stage is highly curable, and treatment usually involves removing the tumor with surgery.

Surgical team operating on a patient.

Treating early stage kidney cancer

Stage 1 kidney cancer is also known as early stage cancer. At this stage, a tumor has formed and has spread from the tissue lining. The tumor is smaller than 7 cm (about 3 inches) and is contained within the kidney. Treatment at this stage is often a partial nephrectomy, or removal of part of the kidney.

Model of a kidney and an adrenal gland.

Treating stage 2 kidney cancer

When kidney cancer reaches stage 2, it means the tumor has grown larger than 7 cm (or 3 inches). It may have invaded one of the major veins within the kidney, such as the renal vein. It may have started growing into tissue around the kidney, but not into the adjacent adrenal gland or beyond. It hasn’t spread to other lymph nodes or organs. Radical nephrectomy, or the removal of the entire affected kidney and the attached adrenal gland, is often the treatment of choice for stage 2 cancer.

Cancer tumor spreading.

Treating stage 3 kidney cancer

At stage 3, the main tumor may be any size and may have grown outside of the kidney. It may have spread to nearby lymph nodes but not to distant lymph nodes or organs. If cancer has grown into nearby large veins, you may need surgery to remove the tumor. During the operation, you may need to be put on a cardiopulmonary bypass machine, which will take over the heart’s pumping action. This allows the heart to be stopped so the cancer can be removed from the large vein leading to the heart.

Doctor showing a patient a chest x-ray.

What is metastatic kidney cancer?

Stage 4 kidney cancer, also known as metastatic kidney cancer, is the most advanced form of the disease. Stage 4 means the cancer has spread to distant lymph nodes or other organs, such as the bones, lung, or bladder. The primary tumor may be of any size and may have grown beyond the kidney. This is often recurrent cancer, meaning the cancer has returned after being previously treated.

Doctor explaining diagnosis to a patient.

Treating metastatic kidney cancer

Treatment for stage 4 cancer focuses on increasing a patient’s life span, controlling the cancer, and lessening symptoms. Surgery may be used to remove as much of the tumor as possible. Nonsurgical options include immunotherapy, or drugs that use your own immune system to fight cancer, or targeted therapy, which targets cancer’s specific genes, proteins, or tissues that contribute to the cancer’s growth.

Rachel Zohn
Meet Our Writer
Rachel Zohn

Rachel Zohn is a mom, a wife, and a freelance writer who is striving to find the best way to juggle it all and maintain a sense of humor. She is a former newspaper reporter with a deep interest in writing about all things related to health, wellness and the human body. She enjoys writing about various health topics, including skin conditions such as eczema, different types of cancer and seasonal allergies.