Kidney Cancer: Grade and Stage

Once your healthcare provider knows you have cancer, the next step is to find out the grade and stage of the cancer. Stage is a way to note the size of the tumor, and if it has spread. Grade is a way to note how abnormal the cancer cells look under a microscope. Staging and grading of cancer is important for deciding how to treat it, and how curable it is.

Grades of kidney cancer

The grade refers to how the cancer cells look when compared to normal kidney cells. The grade of your cancer will help your healthcare provider predict how fast the cancer may grow and spread. The Furhman scale of 1 to 4 is used to grade kidney cancer. The lower the number, the more the cancer cells look like normal cells. This means the cancer can be easier to treat and cure. This is because cancer cells that look more like normal cells tend to grow and spread slowly. Grade 4 cancer look very different from normal kidney cells. This grade of cancer is harder to treat.

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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 (AJCC) 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 the tumor and if it has spread into nearby areas.

• N stands for nodes. Lymph nodes are small organs around the body. They help the body fight infections. This category notes if cancer cells have spread to the nearby lymph nodes.

• M stands for metastasis. This category notes if the cancer has spread to other organs in the body. This may include a lung, your 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 health care provider has determined your T, N, and M values, he or she then determines your stage grouping. The lower numbers mean smaller cancers and that are easier to treat and cure. Here are the 4 stages of kidney cancer:

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

Stage II. The cancer is found only in the 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 the kidney. It has spread to 1 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 the kidney. Or it has grown into the large vein (the vena cava) where blood travels from the kidneys. Cancer may be growing into nearby tissue, but has not spread to any lymph nodes or into 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 the kidney (Gerota's Fascia). Cancer may have also spread to the adrenal gland on top of the kidney. The cancer may be in nearby lymph nodes. It has not spread to distant lymph nodes or organs. 

• The cancer has grown outside the kidney. It has spread to distant lymph nodes or other organs. These may include bones, liver, brain, or lungs. It may also be found in nearby lymph nodes. 

Recurrent. Recurrent cancer has come back after it has been treated. It may come back in the original area. Or it may come back in another part of the body.

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Talking with your healthcare provider

When your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.

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Kidney Cancer: Treatment Choices

There are various treatment choices for kidney cancer. Which may work best for you? It depends on a number of factors. These include the type, size, location, and stage of your cancer. Factors also include your age, overall health, and what side effects you’ll find acceptable.

Learning about your treatment options

You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.

The healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, how successful they’re expected to be, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than 1, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best decision.

Deciding on the best plan may take some time. Talk with your healthcare provider about how much time you can take to explore your options. You may want to get another opinion before deciding on your treatment plan. In fact, some insurance companies may require a second opinion. In addition, you may want to involve your family and friends in this process. 

Understanding the goals of treatment for kidney cancer

Treatment may control or cure the kidney cancer. It can also improve your quality of life by helping to control the symptoms of the disease. The goal of kidney cancer treatment is to do 1 or more of these things:

• Remove the primary kidney cancer tumor or other tumors

• Kill or stop the growth or spread of kidney cancer cells

• Prevent or delay the cancer's return

• Ease symptoms of the cancer, such as pain or pressure on organs

Types of treatment for kidney cancer

Treatment options include:

• Surgery. Surgery to remove the kidney is called a nephrectomy. Surgery is used to remove the kidney with the tumor and any nearby lymph nodes that contain cancer. You may also have surgery to ease pressure or pain. The remaining kidney is often able to do the work of both kidneys.

• Biologic therapy. This is also known as immunotherapy. It uses medicines that work like chemicals that your body’s immune system makes. They help your immune system fight the cancer.

• Radiation therapy. This treatment kills cancer cells with high-energy X-rays. Radiation is most often used when the kidney cancer has spread to certain bones or the brain. It may be used to treat symptoms such as cough or pain.

• Chemotherapy. This treatment uses 1 or more medicines to kill cancer cells or shrink tumors. They work by attacking rapidly growing cells. Regular chemotherapy medicines are not often very effective against kidney cancer.

• Targeted therapy. These are medicines that target specific parts of kidney cancer cells to kill them or slow their growth. These medicines work differently from regular chemotherapy medicines. They’re often used to treat advanced kidney cancer.

• Ablation therapy. There are 2 main types of ablation therapy used to treat kidney cancer. They’re both done by putting a needle into an area of cancer cells. This is a less-invasive treatment that causes less bleeding. It also keeps the side effects to a small area of the body. Radiofrequency ablation (RFA) uses energy waves to kill cancer cells. Cryoablation uses extreme cold to kill cancer cells.

• Supportive care. Your healthcare provider may advise therapies that help ease your symptoms, but don’t treat the cancer. Your healthcare provider may suggest supportive care if he or she believes that available treatments are more likely to do you more harm than good.

Your healthcare provider may suggest that you have more than 1 of these types of treatment. This is sometimes called combination therapy. Newer types of treatment may be available only through a research study. This is called a clinical trial. Talk with your healthcare provider about what clinical trials may be an option for you.