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Stages of Kidney Cancer

Definition of Staging

A staging system lets doctors know if the cancer has spread and to what extent. Staging describes the extent or severity of cancer based on the size of the original (primary) tumor and the extent to which it has spread in the body. There are several staging systems for kidney cancer but the most widely used system in the United States is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer (AJCC).1

General Information on Staging

Staging is based on knowledge of how cancer develops. Cancer cells divide and grow to form a mass of tissue called a growth or tumor. As a tumor grows, it can spread to nearby organs and tissues. Cancer cells may also break away from the tumor and enter the bloodstream or lymphatic system. By moving through the bloodstream or lymphatic system, cancer can spread from the primary site to form new tumors in other organs. The spread of cancer is called metastasis.

Purpose of Staging

Staging helps with the cancer diagnosis and treatment process in important ways, including:

  • Helping the doctors to effectively plan a patient's treatment
  • Estimating the patient's prognosis (likely outcome or course of the disease)
  • Helping to identify clinical trials that may be suitable for a particular patient.1

Staging helps researchers and health care providers exchange information about patients and provide a common language for diagnosis, treatment and clinical trials.

Staging Kidney Cancer

The AJCC staging system includes the primary kidney tumor (T stage), the lymph nodes near the kidney (N stage) and the presence or absence of metastases (M stage) to determine if the cancer has spread. In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery. Pathologic stage is based on the analysis of the tissue that has been surgically removed.


Stage I

The tumor is confined to the kidney. There is no spread to lymph nodes or distant organs.

Stage II

The tumor has invaded the fat around the kidney or the adrenal gland above the kidney. There is no spread to lymph nodes or other organs.

Stage III

There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade other nearby organs or more distant organs.

Stage IV

There are several combinations of T, N, and M categories included in this stage. This stage includes any cancers that have invaded into nearby organs such as the colon (large bowel) or the abdominal wall as well as more distant organs in the body.

Primary Tumor (T):


Primary tumor cannot be assessed


No evidence of primary tumor


Tumor 7.0 cm or less, confined to the kidney


Tumor 4.0 cm or less, confined to the kidney


Tumor 4.0-7.0 cm, confined to the kidney


Tumor greater than 7.0 cm, limited to kidney


Tumor extends into major veins/adrenal/tissue; not beyond Gerota's fascia


Tumor invades adrenal/perinephric fat


Tumor extends into renal vein(s) or vena cava below diaphragm


Tumor extends into vena cava above diaphragm


Tumor invades beyond Gerota's fascia, into adjacent organ systems.

N - Regional Lymph Nodes


Regional nodes cannot be assessed


No regional lymph node metastasis


Metastasis in a single regional lymph node


Metastasis in more than one regional lymph node

M - Distant Metastasis


Distant metastasis cannot be assessed


No distant metastasis


Distant metastasis

  1. "About Kidney Cancer", Kidney Cancer Association, www.kidneycancer.org , URL: http://www.kidneycancer.org/knowledge/learn/about-kidney-cancer

PN 1002326 Rev A 04/2013

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