doctor and patient looking at x-rays

Renal cell carcinoma (RCC) is the most common type of kidney cancer among adults. The exact cause isn’t clear, but smokers and people with a family history of renal cancer are at increased risk. 

Advances in surgical techniques and targeted therapies are improving the outlook. The median overall survival rate of renal cell carcinoma is greater than two years after the cancer is found, but actual survival duration is highly dependent on the stage at which the diagnosis is made.

Like many other types of cancer, RCC has different stages. The stage describes the size of the primary tumor and the extent to which the cancer has spread. Staging helps doctors determine the best treatment plan. It can also provide a general outlook. Lower stage cancers are easier to treat than higher stage cancers, and the survival rate is also better.

About the Staging Process

Your medical team will determine your stage based on early findings gathered through physical examination and imaging tests such as:

However, clinical staging is subject to change. Surgery and post-surgical pathology tests help to provide a more accurate picture. This additional information is used to provide the pathologic stage. 

The TNM system helps provide key information about the cancer:

  • T: signifies the size of the primary tumor and whether it has spread nearby.
  • N: indicates how much cancer has spread to neighboring lymph nodes.
  • M: details whether the cancer has spread, or metastasized, from one part of the body to another. 

Within each of these categories, a number from 0 to 4 follows the letter and indicates the degree of severity. “X” means the information is not available. An example diagnosis looks like this: stage 2: T2, N0, M0.

What Are the Stages of RCC?

There are four stages of RCC, ranging from stage 1 to stage 4.

Stage 1

In stage 1 renal cell carcinoma, the tumor is seven centimeters or less and the cancer has not spread outside the kidney. At this stage, surgery is the most common treatment. Depending on the location of the tumor, the surgeon may opt for laparoscopic or conventional surgery. The goal is to remove the tumor while preserving kidney function. This may involve a simple resection, but in some cases it may warrant removal of the kidney and possible lymph node dissection. In patients who cannot have surgery, other targeted treatments, such as radiation therapy and arterial embolization may be used.

Stage 2

In stage 2, the tumor is larger than seven centimeters, but hasn’t spread beyond the kidney. An aggressive surgical approach is the most effective treatment. Often, this will include removing the kidney, adrenal gland, and fat (perirenal fat) and tissue (Gerota fascia) surrounding the kidney. This may also involve lymph node dissection.

If all of the cancer is removed during surgery, additional treatments (adjuvant treatment) are not usually needed, but close monitoring is required for several years. According to the Cleveland Clinic, this aggressive surgical approach has a cure rate of 40 to 60 percent.

Stage 3

In stage 3, the tumor is any size and located within the kidney, plus one or more neighboring lymph nodes. Stage 3 can also mean that the cancer has been discovered in a major blood vessel in the kidney or the tissue that surrounds the kidney, but hasn’t advanced beyond that. 

Treatment usually requires removing the kidney, adrenal gland, perirenal fat, Gerota fascia, and possibly a lymph node dissection. Adjuvant treatment may not be required, but close follow-up care is necessary. About 30 percent of patients with localized tumors relapse in the first five years after surgery.

Stage 4

In stage 4, the cancer is growing outside the fatty tissue around the kidney. It may have entered the adrenal gland or nearby lymph nodes. Stage 4 may also indicate that the cancer has spread into the lymph system or distant places like the liver, lungs, bones, or brain. Treatment depends on many factors, but the outlook is not as favorable for patients in earlier stages of the disease. 

Knowing your stage of RCC will help your doctor decide which treatment option is best for you.