Stage 4 renal cell carcinoma (RCC) is cancer that has spread beyond the kidneys. It’s also called metastatic or advanced RCC.

When RCC advances to stage 4, the symptoms, treatment options, and expected outcomes are different from those of early-stage RCC. In this article, we’ll outline factors like symptoms, treatment, and life expectancy for stage 4 RCC.

What Is Stage 4 Renal Cell Carcinoma?

RCC is the most common type of kidney cancer, making up about 90 percent of all cases. It starts when cells in the outer part of the kidney, called the renal cortex, begin to grow out of control.

In the early stages of RCC, the cancer is found only in the kidney. As the cancer grows, it can spread to nearby lymph nodes and other organs.

In stage 4 RCC, the cancer has either grown beyond Gerota’s fascia — the thin layer of tissue surrounding the kidney — or has spread to distant parts of the body, a process called metastasis.

How Do Doctors Stage Renal Cell Carcinoma?

Healthcare providers use the TNM staging system to describe the stage of renal cell carcinoma. It looks at three key factors:

• T — The size of the main tumor and whether it has grown into nearby tissues
• N — Whether the cancer has spread to nearby lymph nodes
• M — Whether the cancer has spread to distant parts of the body

With this information, the cancer care team can assign a stage from 1 to 4. (Cancer stages are also written using Roman numerals, such as stage I to stage IV.) A higher stage number means the cancer is more advanced. In kidney cancer, later stages indicate that the cancer has spread more widely in the body.

Stage 4 Renal Cell Carcinoma

RCC can be considered stage 4 in either of two situations. One is when the main tumor grows beyond Gerota’s fascia or into the adrenal gland, which sits on top of the kidney and makes hormones. This type of tumor is called T4 in the TNM system. Even if the cancer hasn’t spread to the lymph nodes or other parts of the body, it’s still considered stage 4.

The second situation is when the cancer has spread to a distant part of the body. This is classified as M1 in the TNM system. In this case, RCC is considered stage 4 no matter the size of the primary tumor or if cancer has spread to the lymph nodes.

How Common Is Stage 4 Renal Cell Carcinoma?

According to data from the National Cancer Institute (NCI), 15 percent of people with kidney or renal pelvis cancer are diagnosed with metastatic cancer. It’s important to know that this includes people with other types of kidney cancer, as well as people with RCC.

Fewer people are being diagnosed with metastatic RCC because doctors can now find the cancer earlier using better tests. However, about 30 percent of people who are first diagnosed with early-stage RCC may eventually develop metastatic RCC.

Where Does Stage 4 Renal Cell Carcinoma Spread?

RCC often spreads to the lymph nodes first. Once in the lymph nodes, RCC can spread to other organs in the body, including:

• Lungs
• Bone
• Liver
• Adrenal glands
• Brain

Less commonly, RCC can spread to the thyroid, pancreas, or digestive tract.

What Are the Symptoms of Stage 4 Renal Cell Carcinoma?

Many people with early-stage RCC don’t have any symptoms. However, as the kidney tumor grows larger, it can begin to cause signs and symptoms, such as:

• Hematuria (blood in the urine)
• Pain in the sides or lower back
• A lump in the flank or abdomen
• Swelling in the legs and feet
• Enlarged veins in the scrotum
• Fever
• Night sweats
• High blood pressure
• High calcium levels in the blood
• Anemia (low red blood cell count)

If RCC spreads to other organs, it can lead to different symptoms depending on which organ is affected. Metastatic RCC symptoms may include:

• Swollen lymph nodes (if cancer spreads to the lymph nodes)
• Shortness of breath and coughing (if cancer spreads to the lungs)
• Bone pain and bone fractures (if cancer spreads to the bones)
• Jaundice (yellowing of the skin and eyes) and abdominal swelling (if cancer spreads to the liver)
• Back pain and digestion problems (if cancer spreads to the adrenal glands)
• Headaches and seizures (if cancer spreads to the brain)

How Is Stage 4 Renal Cell Carcinoma Diagnosed?

Imaging tests, such as a CT scan or ultrasound, can help healthcare providers diagnose RCC. Additional testing may be needed if a person has symptoms of metastasis or if RCC cells look abnormal under a microscope — a sign of a higher grade.

The grade of cancer refers to how different cancer cells look compared to normal kidney cells under a microscope. In RCC, cancer cells can be graded from 1 to 4. Grade 1 means the cancer cells look more similar to normal cells. Low-grade cancers are less likely to grow quickly or spread to other parts of the body. High-grade cancers look less like normal kidney cells and are more likely to grow quickly and metastasize.

Additional testing to look for RCC that’s spread to other parts of the body may include:

• CT scan
• MRI
• Chest X-ray
• Bone scan
• PET scan
• Biopsy (taking a tissue sample) of the affected organ

How Is Stage 4 Renal Cell Carcinoma Treated?

In most cases, stage 4 RCC can’t be cured. Treatments for people with this stage focus on controlling cancer growth and relieving symptoms. The best treatment plan is based on several factors, including:

• The size and location of the tumor
• The cancer grade
• The subtype of RCC
• What symptoms a person has
• Past cancer treatments
• A person’s overall health

In early-stage RCC, the main treatment is either partial nephrectomy (surgery to remove part of the kidney) or radical nephrectomy (removal of the entire kidney). Which approach is best for a particular diagnosis depend on factors include the tumor’s size and location.

However, surgery isn’t always an option for people with stage 4 RCC. In this case, the main treatment for stage 4 RCC is often a combination of immunotherapy drugs and targeted therapy drugs.

If stage 4 RCC hasn’t spread far, a radical nephrectomy to remove the whole kidney and nearby tissue may be an option. If the person is healthy enough, surgery to take out the kidney tumor, followed by drug treatment, may help. This is called a cytoreductive nephrectomy — a surgery that removes as much cancer as possible to help other treatments work better. If the cancer has only spread to a few spots, doctors may also remove those tumors.

Stage 4 RCC can be difficult to treat. Clinical trials are testing new treatments and new combinations of existing treatments to find better treatment options. Many people with RCC may be candidates for a clinical trial. Talk to your cancer care team to see if you qualify for a clinical trial in your area.

Other treatments that can help relieve symptoms and improve quality of life (called supportive and palliative treatments) may include:

• Radiation therapy
• Arterial embolization (a procedure that blocks the blood supply to the kidney tumor)
• Pain medications
• Drugs to improve appetite
• Drugs to improve sleep

What Is the Life Expectancy With Stage 4 Renal Cell Carcinoma?

Although new treatments have improved stage 4 RCC care, people with stage 4 RCC often have a poor prognosis (outlook). The survival rate of RCC can be used as a measure of life expectancy. A survival rate refers to the percentage of people with RCC who are still alive after a specific amount of time.

The NCI Surveillance, Epidemiology, and End Results (SEER) program collects information about how many people are still alive five years after a kidney cancer diagnosis, known as the five-year relative survival rate. According to the SEER database, kidney cancer that’s spread to distant parts of the body has an 18 percent five-year relative survival rate.

It’s important to remember that the life expectancy with stage 4 RCC is different for each person. Several factors can play a role in the prognosis of stage 4 RCC, including the subtype and grade of your cancer and what symptoms you have.

New immunotherapies and targeted therapy drugs have increased the life expectancy for people with metastatic RCC. According to the journal Scientific Reports, about half of the people with metastatic kidney cancer live at least four years.

Talk to your cancer care team about the factors that may affect your prognosis.

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On MyKidneyCancerTeam, the social network for people living with kidney cancer and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with kidney cancer.

Have you or a loved one been diagnosed with stage 4 renal cell carcinoma? How did your diagnosis affect your treatment plan and prognosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.