Staging and grading of kidney cancer
What is staging and grading?
Your cancer doctor uses information from your test results to advise on the best treatment for you. This information includes the following:
- the type of kidney cancer you have
- the stage of the cancer – this describes its size and whether it has spread
- the grade of the cancer – this gives an idea of how quickly the cancer might grow and spread.
Your cancer doctor and specialist nurse will talk to you about this. They will explain how it helps you and your doctor decide on your treatment plan.
We understand that waiting to know the stage and grade of your cancer can be a worrying time. We are here if you need someone to talk to. You can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat to our specialists online.
Staging and grading of kidney cancer
TNM staging system
The most commonly used staging system for kidney cancer is the TNM system.
- T describes the size of the tumour.
- N describes whether lymph nodes are affected.
- M describes whether the cancer has spread to other parts of the body (metastases).
Tumour
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T1
T1 means the cancer is only inside the kidney and is no bigger than 7cm. It is divided into:
- T1a – the cancer is 4cm or smaller
- T1b – the cancer is bigger than 4cm.
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T2
T2 means the cancer is only inside the kidney and is bigger than 7cm. It is divided into:
- T2a – the cancer is between 7cm and 10cm
- T2b – the cancer is bigger than 10cm.
Image: The structure of the kidney -
T3
T3 means the cancer is growing into the fat around the kidney, or into a major vein close to the kidney (the renal vein or vena cava). It is not growing outside the capsule that surrounds the kidney. T3 is divided into:
- T3a – the cancer is growing into the fat around the kidney, or into the renal vein
- T3b – the cancer is growing into the vena cava in the tummy (abdomen)
- T3c – the cancer is growing into the vena cava in the chest, or into the wall of the vena cava.
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T4
T4 means the cancer has spread through the capsule that surrounds the kidney. It may have grown into the adrenal gland.
Nodes
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N0
N0 means there are no cancer cells in any lymph nodes near the tumour.
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N1
N1 means there are cancer cells in 1 or more of the lymph nodes near the tumour.
If the cancer cells have spread to the lymph nodes, doctors will say the nodes are positive.
Metastasis
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M0
M0 means the cancer has not spread to other parts of the body further away from the kidney.
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M1
M1 means the cancer has spread to parts of the body further away from the kidney – for example, the bones, lungs, liver or brain, or lymph nodes in another part of the body. If the cancer has spread, it is called secondary or metastatic kidney cancer.
Number staging system
This system brings together information from the TNM stages and gives the cancer a number stage. These range from stages 1 to 4.
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Stage 1 kidney cancer
The cancer is 7cm or smaller and is inside the kidney. It has not spread to the lymph nodes or other organs.
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Stage 2 kidney cancer
The cancer is bigger than 7cm and is inside the kidney. It has not spread to the lymph nodes or other organs.
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Stage 3 kidney cancer
The cancer is growing into the fat around the kidney, or into one of the major veins close to the kidney (the renal vein or the vena cava). It is not growing through the capsule that surrounds the kidney. It may or may not have spread to the lymph nodes.
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Stage 4 kidney cancer
The cancer has grown through the capsule that surrounds the kidney and into nearby areas. Or the cancer has spread to other parts of the body further away from the kidney.
Other terms used
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Early or local
A small cancer that has not spread.
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Locally advanced
Cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
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Local recurrence
Cancer that has come back in the same area after treatment.
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Secondary, advanced, widespread or metastatic
Cancer that has spread to other parts of the body.
Related pages
Grading of kidney cancer
A doctor decides the grade of the cancer by looking at the cancer cells under a microscope. The grade gives an idea of how the cancer might grow or spread.
Kidney cancers are usually given a grade from 1 to 4. This is called the Fuhrman system. The lower the number, the lower the grade.
- Low grade means the cancer cells are more like normal cells. Grade 1 and 2 cancer cells grow slowly and are less likely to spread.
- High grade means the cancer cells are less like normal cells. Grade 3 and 4 cancer cells grow more quickly and are more likely to spread.
About our information
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References
Below is a sample of the sources used in our kidney cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk
Escudier B, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 30: 706-720, 2019. doi:10.1093/annonc/mdz056 Published online 21 February 2019. Available from www.annalsofoncology.org/action/showPdf?pii=S0923-7534%2819%2931157-3 (accessed April 2021).
European Association of Urology. Renal cell carcinoma guidelines. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4. Available from www.uroweb.org/guideline/renal-cell-carcinoma (accessed April 2021).
National Institute for Health and Care Excellence (NICE): Nivolumab with ipilimumab for untreated advanced renal cell carcinoma. Technology appraisal guidance (TA581). Published 15 May 2019. Available from www.nice.org.uk/guidance/ta581 (accessed April 2021).
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Reviewers
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Lisa Pickering, Consultant Medical Oncologist.
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Date reviewed
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