Grading and Staging Kidney Cancer

Your healthcare team will assign a grade and stage of your kidney cancer. The grade and stage determines the severity of your kidney cancer. Here's what you should know.

Once your healthcare provider knows you have kidney cancer, the next step is to determine its size and if it has spread, which establishes its stage.

After determining how abnormal the cancer cells look under a microscope, your doctor assigns the cancer a grade.

YOU MIGHT ALSO LIKE: What Is Kidney (Renal) Cancer?

Grades of kidney cancer

The grade of your kidney cancer will help your healthcare team predict how fast the cancer may grow and spread.

The Furhman grade of 1 to 4 is used to grade kidney cancer. The lower the number, the better.

Grade 1 cancer cells look more like normal cells and tend to grow and spread more slowly. Grade 4 cancer cells look very different from normal kidney cells. This grade of cancer is harder to treat.

Stages of kidney cancer

The stage of your cancer describes the size of a tumor and how much it has spread. Healthcare providers use different rating systems to stage cancer. The American Joint Committee on Cancer staging system is used most often for kidney cancer. It’s called the TNM system.

• T stands for tumor. This category notes the size of your tumor and whether it has spread to nearby areas.
• N stands for nodes. Lymph nodes are small organs around your body. They help your body fight infections. This category notes whether cancer cells have spread to nearby lymph nodes.
• M stands for metastasis. This category notes if the cancer has spread to other organs in your body. This may include your lung, bones, liver, or brain. It also includes lymph nodes that are not near your kidneys.

Numbers from 0 to 4 are assigned to the T, N, and M categories. Once your healthcare team determines your T, N, and M values, they assign a stage. Lower numbers mean smaller cancers that are easier to treat and cure.

The stages of kidney cancer are:

Stage 1

The cancer is found only in your kidney. It is 7 centimeters (cm) (about 2.75 inches) or less in diameter.

Stage II

The cancer is found only in your kidney. The tumor is larger than 7 cm in diameter.

Stage III

In this stage, one of the following is true:

• The cancer may have spread outside your kidney. It has spread to one or more nearby lymph nodes. The cancer has not spread to distant lymph nodes or distant organs. 
• Cancer has grown into the main blood vessels of your kidney. Or it has grown into the large vein that blood from your kidneys goes (vena cava). It may be growing into nearby tissue but has not spread to any lymph nodes or the adrenal gland. It has not spread to distant organs.

Stage IV

In this stage, one of the following is true:

• The cancer has spread outside the tissue covering of your kidney (Gerota's Fascia). Cancer may have also spread to the adrenal gland on top of your kidney. The cancer may be in nearby lymph nodes. It has not spread to distant lymph nodes or organs. 
• The cancer has grown outside your kidney. It has spread to distant lymph nodes or other organs. These may include your bones, liver, brain, or lungs. It may also be found in nearby lymph nodes. 

Recurrent kidney cancer

Recurrent cancer has returned after treatment. It may come back in the original area; it may come back in another part of your body.

Talking with your healthcare team

When you speak to your healthcare providers about the stage of your kidney cancer, ask questions and talk about your concerns.

YOU MIGHT ALSO LIKE: Our Kidney Cancer section