TNM stages of kidney cancer

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

Doctors use a staging system called TNM. TNM stands for Tumour, Node and Metastasis.

  • T describes the size of the tumour (cancer)
  • N describes whether the cancer has spread to nearby lymph nodes Open a glossary item
  • M describes whether the cancer has spread to other parts of the body, such as the lungs

Doctors may also use a number staging system for kidney cancer. Stage 1 is the earliest stage and stage 4 is the most advanced.

T stages of kidney cancer

The T stage describes the size of the cancer.

There are 4 T stages of kidney cancer. T1 is the smallest and T4 is the largest.

T1 kidney cancer

The cancer is 7cm across or smaller and is completely inside the kidney.

T1 is divided into T1a and T1b depending on how big the cancer is:

  • T1a means the cancer is 4cm across or smaller
  • T1b means the cancer is between 4 and 7cm across

If the cancer hasn't spread to the lymph nodes or other parts of the body, T1 kidney cancer is the same as number stage 1.

T2 kidney cancer

The cancer is more than 7cm across and is completely inside the kidney.

T2 is divided into T2a and T2b:

  • T2a means the cancer is between 7 and 10cm across
  • T2b means the cancer is more than 10cm across

If the cancer hasn't spread to the lymph nodes or other parts of the body, T2 kidney cancer is the same as number stage 2.

T3 kidney cancer

The cancer has grown into the surrounding tissues, or main blood vessels such as the renal vein. It may also have grown into the large blood vessel that takes blood back to the heart (vena cava).

The cancer has not spread into the adrenal gland or beyond the layer of tissue around the kidney (fascia).

T3 is divided into T3a, T3b, and T3c.

T3a kidney cancer

T3a means the cancer has grown into the nearby tissues or the renal vein.

T3b kidney cancer

T3b means the cancer has grown into the vena cava, but hasn't spread above the diaphragm Open a glossary item.

T3c kidney cancer

T3c means the cancer has grown into the vena cava and spread above the diaphragm. Or has grown into the wall of the vena cava.

T4 kidney cancer

The cancer has spread beyond the layer of tissue around the kidney (fascia). It might have spread into the adrenal gland above the kidney.

N stages of kidney cancer

The N stage describes whether the cancer has spread to the lymph nodes near the kidney:

  • N0 means there are no cancer cells in the lymph nodes near the kidney
  • N1 means there are cancer cells in one or more lymph nodes near the kidney 

M stages of kidney cancer

The M stages describe whether the cancer has spread to a different part of the body (metastases).

The M stage is split into M0 and M1:

  • M0 means the cancer has not spread to another part of the body
  • M1 means the cancer has spread to another part of the body, such as the lungs or lymph nodes that are further away from the kidney

Cancer that has spread to another part of the body is called advanced or metastatic cancer. Where the cancer has spread to is called the secondary cancer.

M1 kidney cancer is the same as number stage 4.

Treatment for kidney cancer

The stage of the cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • the type of cancer (the type of kidney cells the cancer started in)
  • how much the cancer cells look like normal cells (the grade of the cancer cells)
  • where the cancer is in your kidney
  • other health conditions that you have

Treatment may include:

  • surgery to remove the part of the kidney where the cancer is (partial nephrectomy) or the whole kidney (radical nephrectomy)
  • freezing therapy (cryotherapy)
  • microwave ablation (MWA) or radiofrequency ablation (RFA)
  • blocking the blood supply to the cancer (renal artery embolisation)
  • targeted cancer drugs or immunotherapy
  • radiotherapy
  • AJCC Cancer Staging Manual Eighth Edition
    American Joint Committee on Cancer
    Springer, 2017

  • Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
    B Escudier and others
    Annals of Oncology, 2019. Volume 30, pages 706 to 720

  • EAU guidelines on renal cell carcinoma 
    European Association of Urology (EAU), 2023

Last reviewed: 
23 Jan 2024
Next review due: 
23 Jan 2027

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