Understanding Kidney Cancer

What Are the Kidney Cancer Stages and Classifications?

Last updated and reviewed on June 13, 2026.

Once kidney cancer is diagnosed, the next step is staging, figuring out how far the cancer has grown or spread. Staging is critical because it guides the treatment plan and helps doctors and patients understand the likely outcome (prognosis). Kidney cancer is staged using a system called the TNM system (Tumor, Node, Metastasis), which is then combined into an overall stage from I to IV.

Understanding Staging

The TNM system looks at three key things:

• T (Tumor): How big is the main tumor, and has it grown into nearby structures?
• N (Node): Has cancer spread to nearby lymph nodes?
• M (Metastasis): Has cancer spread to distant parts of the body, like the lungs, liver, or bones?

Based on the T, N, and M values assigned after testing and imaging, a doctor combines them into one of four overall stages.

What Are the Kidney Cancer Stages?

Stage I. The tumor is 7 cm (about 2.75 inches) or smaller and is completely within the kidney. It has not spread to lymph nodes or distant organs. This is early-stage kidney cancer with an excellent prognosis. Most Stage I tumors can be treated with surgery, and survival rates are very high.

Stage II. The tumor is larger than 7 cm but is still completely within the kidney. It has not spread to lymph nodes or distant organs. Stage II is still localized, and surgery is the standard treatment.

Stage III. The cancer has grown beyond the kidney in one of several ways: it may have grown into the surrounding fatty tissue, spread into the adrenal gland sitting on top of the kidney, or grown into major blood vessels like the renal vein or the inferior vena cava (a large vein that carries blood to the heart). Stage III cancer may also have spread to nearby lymph nodes. However, it has not yet spread to distant organs. Stage III kidney cancer can often still be treated surgically, though it requires more complex surgery, and additional treatment may be recommended.

Stage IV. This is the most advanced stage. The cancer has either grown into nearby organs beyond the fatty tissue layer around the kidney (such as the bowel or the abdominal wall), or it has spread to lymph nodes beyond the immediate kidney area, or it has spread to distant organs such as the lungs, bones, liver, or brain. Stage IV kidney cancer is also called metastatic kidney cancer. Treatment focuses on systemic therapies (targeted therapy and immunotherapy), though surgery may still play a role in some patients.

In addition to stage, doctors also assess tumor grade. Grade describes how abnormal the cancer cells look under a microscope. The most widely used system for renal cell carcinoma is the WHO/ISUP (International Society of Urological Pathology) grading system, which grades tumors from 1 to 4.

Grade 1 and 2 tumors look more like normal kidney cells and tend to grow more slowly. Grade 3 and 4 tumors look very abnormal and tend to grow and spread faster. A high-grade tumor in an early stage is still more concerning than a low-grade tumor of the same stage.

Questions to Ask Your Doctor About Your Stage

Coming to your appointments with prepared questions is one of the most powerful things you can do. Research shows that patients who actively participate in their care make decisions that better align with their own values and feel more confident throughout treatment.

Second Opinions: It is completely appropriate and often very helpful to seek a second opinion about your diagnosis and staging. Major kidney cancer centers often have multidisciplinary teams (urologists, medical oncologists, radiation oncologists, and pathologists who specialize in kidney cancer) who review cases together. If you are not already being seen at a specialized center or by a kidney cancer specialist, ask your doctor about a referral. The more expertise involved in your care, the more confidence you can have in the plan made for you.

Questions to ask your doctor about your stage:

• What stage and grade is my kidney cancer?
• What does my stage mean for my treatment options and prognosis?
• Has the cancer spread anywhere else in my body? Were all necessary staging tests performed?
• Has the tumor grown into blood vessels or nearby lymph nodes?
• Is my staging final, or do we need additional tests?
• Will my case be reviewed by a multidisciplinary team?
• Would a second opinion on my pathology or staging be helpful?
• What does my tumor grade mean for how aggressive this cancer is likely to be?

Understanding your stage and grade is the foundation for all the treatment decisions that come next.

Sources:

1. American Cancer Society. Kidney Cancer Stages. https://www.cancer.org/cancer/types/kidney-cancer/detection-diagnosis-staging/staging.html
2. American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 8th Edition. Kidney chapter. 2017.
3. National Cancer Institute. Renal Cell Cancer Treatment (PDQ) – Patient Version. https://www.cancer.gov/types/kidney/patient/kidney-treatment-pdq
4. Motzer RJ, et al. NCCN Clinical Practice Guidelines: Kidney Cancer. Journal of the National Comprehensive Cancer Network. 2022.
5. Moch H, et al. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs. European Urology. 2016.