Kidney cancer (also called renal cancer) is categorized into stages to explain how far the cancer has grown and whether it’s metastasized (spread) to other parts of the body. Knowing the stage of kidney cancer helps healthcare providers choose the most effective treatment and helps people living with the condition know what to expect.

If you or a loved one has been diagnosed with kidney cancer, learning about the staging system can help you feel more informed and in control. In this article, we’ll explain the different stages of kidney cancer, highlight common symptoms in each stage, and discuss the treatment options that are most often recommended.

How Is Kidney Cancer Staged?

Once diagnosed, kidney cancer is assigned stages from stage 1 to stage 4. These stages may also be written using Roman numerals, such as stage I to stage IV. In general, an earlier stage means the cancer is smaller and hasn’t spread much, while a later stage means it may have grown or spread to other parts of the body.

To figure out the stage, the cancer care team relies on results from several diagnostic tests, including:

• A physical exam
• Imaging tests (like CT scans or MRIs)
• A biopsy (where a small piece of kidney tissue is removed and tested in a lab)

The stage of kidney cancer can change after surgery. Before surgery, doctors use all the available information to estimate the stage as accurately as possible. During surgery, the surgeon can examine the area around the kidney more closely, and lab tests on tissue removed during surgery can offer more details. This may lead to a more precise final stage.

The TNM Staging System

Like many other types of cancer, kidney cancer is most often staged using the TNM system. This system looks at three primary factors to help describe how advanced the cancer is:

• Tumor size (T) — Describes how large the tumor is and whether it has grown into nearby tissue
• Lymph node involvement (N) — Indicates whether cancer has spread to nearby lymph nodes, which are small, bean-shaped structures that help the body fight infection and disease
• Metastasis (M) — Shows whether the cancer has spread to distant parts of the body

Letters and numbers are added after each category to provide more specific details. Later letters and larger numbers mean the cancer is more advanced. For example:

• T1 — A tumor that is 7 centimeters (about 3 inches) or smaller and limited to the kidney
• T2 — A tumor larger than 7 centimeters, still confined to the kidney
• T4 — A tumor that has spread beyond the kidney into nearby structures

Once the cancer care team has assigned values for each of these three categories, they use that information to determine the cancer’s overall stage.

1. Stage 1 Kidney Cancer

In stage 1, cancer is found only in one kidney and is smaller than 7 centimeters. At this stage, the cancer has not spread to nearby lymph nodes or other parts of the body.

Symptoms of Stage 1 Kidney Cancer

Most people with early-stage kidney cancer don’t notice any symptoms. In many cases, kidney cancer is found by chance during tests for another health issue.

Treatment for Stage 1 Kidney Cancer

Some people with small, early-stage tumors may not need treatment right away. Instead, the cancer care team may suggest active surveillance, which involves regular imaging tests like CT scans or ultrasounds to track tumor growth. Treatment may only be needed if the tumor grows or shows other concerning signs.

Surgery

When treatment is needed, surgery is often the primary treatment with stage 1 kidney cancer. Depending on the tumor size and a person’s overall health, doctors may recommend a partial nephrectomy (removal of part of the kidney) or a radical nephrectomy (removal of the entire kidney). Follow-up imaging, such as CT scans or ultrasounds, is typically done every three to 12 months. Sometimes, nearby lymph nodes are also removed to lower the chance of cancer spreading.

Ablation Therapy

If the kidney tumor is smaller than 4 centimeters and surgery isn’t an option, ablation therapy may be considered. Ablation uses heat, cold, or energy to destroy cancer cells. Common types include cryotherapy (freezing the tumor) and radiofrequency ablation (heating the tumor).

Adjuvant Therapy

Most people don’t need further treatment after surgery. However, additional testing can help predict whether the cancer might return. If the risk of recurrence (cancer returning) is high, immunotherapy may be recommended for about a year to help the immune system target any remaining cancer cells.

2. Stage 2 Kidney Cancer

In stage 2 kidney cancer, the tumor is larger than 7 centimeters but is still completely inside the kidney. Like stage 1, it has not spread to nearby lymph nodes or distant parts of the body.

Symptoms of Stage 2 Kidney Cancer

Many people with stage 2 kidney cancer do not experience symptoms. This is because symptoms often appear only when the tumor begins to affect surrounding tissues. Since the cancer is still limited to the kidney at this stage, most people don’t notice any symptoms.

Treatment for Stage 2 Kidney Cancer

Treatment for stage 2 kidney cancer is often similar to that for stage 1, since the cancer is still confined to the kidney. Surgery is usually the main treatment option. However, for larger tumors, partial nephrectomy or ablation therapy may not be appropriate.

For people who can’t have or choose not to have surgery, radiation therapy may be considered, though it’s less commonly used for kidney cancer.

Follow-up care typically includes imaging tests, such as CT scans or ultrasounds, every three to six months for the first three years to check for any signs of the cancer returning.

3. Stage 3 Kidney Cancer

Stage 3 kidney cancer is also known as locally advanced kidney cancer. In this stage, the kidney tumor has begun to grow outside of the kidney and into nearby tissues or has spread to nearby lymph nodes. It has not spread to distant lymph nodes or organs.

A primary tumor of any size that is still inside the kidney can be considered stage 3 if it has spread to nearby lymph nodes. This stage can also include tumors that have started to grow into the tissue around the kidney or into major blood vessels such as the renal vein or inferior vena cava (a large vein that carries blood to the heart).

At this point, the cancer has not spread to the adrenal gland (a small gland on top of each kidney) or beyond the fascia — a thin layer of tissue surrounding the kidney and adrenal gland. People with stage 3 kidney cancer may have cancer in nearby lymph nodes, but the cancer hasn’t spread to distant parts of the body.

Symptoms of Stage 3 Kidney Cancer

People with stage 3 kidney cancer may begin to experience symptoms related to cancer spread to nearby tissues. Symptoms may include:

• Blood in the urine
• Flank pain (pain on the sides or lower back)
• A lump or mass found on the flanks
• Unintentional weight loss
• Swelling in the lower legs and feet
• Anemia (low levels of red blood cells)

Treatment for Stage 3 Kidney Cancer

There are several treatment options available for people with stage 3 kidney cancer. Commonly recommended treatments include:

• Radical nephrectomy
• Immunotherapy — Drugs that help the immune system recognize and attack cancer cells
• Targeted therapy — Medications that block cancer cell growth by targeting specific genes or proteins
• Radiation therapy — Use of high-energy rays to kill cancer cells or shrink tumors (less commonly used)

4. Stage 4 Kidney Cancer

Stage 4 kidney cancer, also known as advanced kidney cancer, means the cancer has metastasized beyond the kidney, possibly into nearby structures like the fascia or the adrenal gland. It may also have reached distant parts of the body, such as the lungs, bones, liver, or brain. Tumors can be any size, and there may or may not be lymph node involvement. People at this stage are often described as having metastatic disease.

Symptoms of Stage 4 Kidney Cancer

Symptoms of stage 4 kidney cancer may be similar to those in stage 3, as the cancer continues to affect nearby tissues. However, people may also develop additional symptoms depending on where the cancer has spread, such as:

• Fever
• Night sweats
• Unintentional weight loss
• Tiredness or fatigue (tiredness that does not improve with rest)
• Shortness of breath
• Abdominal pain

Treatment for Stage 4 Kidney Cancer

Stage 4 kidney cancer treatment can depend on where the cancer has spread and a person’s overall health. Treatment options may include:

• Immunotherapy and targeted therapy drugs
• Radical nephrectomy or other surgeries
• Ablation treatments
• Radiation therapy

Follow-up in this stage consists of imaging every six to 16 weeks, adjusted based on a person’s health and treatment response.

Clinical trials may also be an option. These studies test new treatments or drug combinations and may provide access to therapies not yet widely available.

Talk to Your Doctor About What Stage Means for You

Understanding the stage of kidney cancer is a key step in managing the condition and making informed decisions about care. Whether you or a loved one is living with an early-stage tumor or advanced, metastatic disease, knowing the stage helps guide treatment options and sets expectations for what’s ahead.

It's also important to stay aware of any new or changing symptoms. Kidney cancer can change or return after treatment, so keeping track of symptoms and sharing updates with your doctor can help catch a recurrence or stage progression early. Regular follow-ups and imaging tests are essential parts of ongoing care. Don’t hesitate to ask your healthcare team questions — they can help you understand what to watch for and what each change might mean.

Find Your Team

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.

When you received your kidney cancer diagnosis, did your doctor explain details about the stage of your cancer? Share your experience in the comments below, or start a conversation by posting on your Activities page.