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Stage 4 kidney cancer is the most advanced stage of kidney cancer. It’s a hard diagnosis to receive, but you’re not alone. Understanding your condition can help you feel more in control and prepared to talk with your cancer care team.
In this article, we’ll help you understand what this stage means, what symptoms to expect, and how treatments may help. We’ll also talk about life expectancy and survival rates for people living with stage 4 kidney cancer.
In stage 4, cancer has spread outside the kidney. It may have reached nearby organs, like the adrenal glands, or it may have spread to other parts of the body, such as the lungs, bones, liver, or brain. When cancer spreads within the body, it’s called metastatic kidney cancer.
Doctors use a staging system called TNM. This system helps describe how much cancer is in the body and where it’s located. Each letter in the TNM system describes different information about the cancer:
Kidney cancer is considered stage 4 when it’s spread into the adrenal glands or to different organs.
Doctors confirm stage 4 using imaging tests like:
Blood tests can also show how the cancer may be affecting your organs. For example, high calcium levels or high red blood cell counts can be signs of widespread cancer. Understanding your stage helps your oncology team choose the best treatment plan for your individual needs.
What type of kidney cancer you have might also play a role in staging. Most people with kidney cancer have a type called renal cell carcinoma (RCC). The most common type is clear cell RCC, but other types include papillary and chromophobe RCC.
Knowing where kidney cancer has spread helps your care team decide on the best treatment options and how to manage your symptoms. Common sites of kidney cancer metastasis include:
In rare cases, the cancer can spread to other areas, too. These might include the scalp, forearm, jaw, skeletal muscle, or breast.
Unfortunately, many people with kidney cancer don’t start noticing symptoms until the disease is in advanced stages. When cancer symptoms appear, they may be caused by the tumor growing larger, pressing on nearby organs, or spreading to other parts of the body.
General symptoms of advanced kidney cancer can include:
Other health problems can cause these symptoms, too. But if you notice any, be sure to let your healthcare team know.
When kidney cancer spreads to other parts of the body, symptoms can depend on where the cancer has traveled. These are called metastatic symptoms. For example, in lung metastasis, symptoms might include shortness of breath, coughing, or chest pain. Metastasis in the bones can cause bone pain and fractures.
When the cancer has spread to the liver, symptoms might include jaundice (skin yellowing) or swelling in the body. If cancer has reached the brain, it can cause headaches, dizziness, or seizures. If you develop any new or worsening symptoms, let your healthcare team know right away.
Treatment options for stage 4 kidney cancer usually involve systemic therapy. This means the treatment works throughout your entire body, not just where the tumor started. Surgery may be a part of your treatment plan as well. Your healthcare team will consider your overall health, the type of kidney cancer you have, and where it’s spread before recommending a treatment plan.
Immunotherapy is a type of treatment that helps your immune system recognize and attack cancer cells. For kidney cancer, immunotherapy drugs target important proteins that help cancer cells grow. In general, side effects of immunotherapy can include:
Targeted therapy drugs block cancer signals that cancer cells use to survive and grow. For kidney cancer, targeted therapy includes drugs that stop tumors from growing new blood vessels. This helps prevent the tumor from getting oxygen and nutrients.
Anti-angiogenic drugs are medications that help stop cancer from growing by blocking the growth of new blood vessels that feed tumors. Because these drugs prevent new blood vessels from forming, they can slow down the healing of small wounds like cuts and bruises. Other common side effects may include:
In some cases, surgery may still be helpful, especially if the tumor is causing pain or bleeding. It might also be done if taking out the tumor could help other treatments work better.
Like any major surgery, surgery for kidney cancer comes with some risks and possible complications. The most common risks are bleeding, damage to nearby organs, and infection at the incision (surgery) site. Other problems, due to reduced kidney function over time, are also possible. This can lead to hypertension or more serious signs of chronic kidney disease.
Radiation therapy (or radiotherapy) may be an option for advanced kidney cancer. It can be used to relieve pain or shrink tumors, especially if the cancer has spread to the bones or brain. It’s common for radiotherapy to lead to tiredness, nausea, or irritation in the area being treated. If used for metastatic cancer, such as in the brain or bones, it may lead to specific side effects based on those areas.
Your oncologist may also be able to help you join a clinical trial. Some clinical trials test new drugs or treatment combinations that may not be widely available yet. If you’re interested in learning more, talk to your cancer care team.
Many factors can affect your prognosis, or outlook, with stage 4 kidney cancer. These can include:
The type of kidney cancer also matters. People with stage 4 clear cell renal cell carcinoma may respond better to immunotherapy than those with other types. Papillary, chromophobe, and other non-clear cell RCC types often need different treatments and may not respond well to standard therapies. People with cancer cells that have sarcomatoid features — which look a certain way under the microscope — tend to have a poorer outlook.
According to the American Cancer Society, the five-year survival rate for stage 4 kidney cancer is approximately 18 percent. That means that out of 100 people diagnosed with stage 4 kidney cancer, 18 are expected to live at least five years after their diagnosis.
However, the data used to calculate these numbers was based on information from individuals diagnosed between 2014 and 2020. With advancements in treatments, including immunotherapy and targeted therapies, outcomes may be improving. Also, survival rates are just an average. Individual outcomes can vary widely depending on someone’s overall health, response to treatment, and the specific aspects of their cancer.
Getting emotional and practical support can make a big difference. Ask your healthcare team about local support groups, mental health counseling, or palliative care. Taking time for rest, connection, and self-care can improve your quality of life with stage 4 kidney cancer.
On MyKidneyCancerTeam, people with kidney cancer and their loved ones come together to ask questions, give advice, and share their stories with others who understand life with kidney disease.
Have you been diagnosed with stage 4 kidney cancer? What has your journey been like? Share your story in the comments below, or start a conversation by posting on your Activities page.
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