Grading and Staging

Kidney Cancer Stage 1
Kidney Cancer Stage 1
Cancer Research UK

Kidney Cancer Stage 2
Kidney Cancer Stage 2
Cancer Research UK

Kidney Cancer Stage 3
Kidney Cancer Stage 3
Cancer Research UK

Kidney Cancer Stage 4
Kidney Cancer Stage 4
Cancer Research UK

Grade and stage are two important ways to measure and describe how cancer develops. A tumor grade tells how aggressive the cancer cells are. A tumor stage tells how much the cancer has spread. 


Your healthcare provider may use a special grading system for your kidney disease. This grading system uses numbers or letters that give details about the tumor. The grades 1 through 4 show increasing severity with "1" being the lowest level and "4" the highest. A higher grade and more advanced stage usually mean larger tumor size and more aggressive tumors. Your doctor can only grade your tumor by looking at it under a microscope.


Following the American Joint Committee on Cancer (AJCC) guidelines, kidney cancer is staged using the tumor node metastases (TNM) system. This system describes the tumor in three specific ways:

  • T describes the size of the main (primary) tumor and whether it has grown into nearby areas.
  • N tells us how much it has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-sized collections of immune system cells.
  • M tells us about metastasis  whether the cancer has spread (metastasized) to other parts of the body. Spread is most common to the lungs, bones, liver, brain, and far off lymph nodes.

Stage I and II tumors include cancers of any size that are only inside the kidney.
Stage III tumors are either locally invasive (T3) or involve lymph nodes (N1). This is cancer that is only found within the kidney organ.
Stage IV tumors have spread beyond the kidney into organs nearby (T4) or distant metastases (M1).

TNM Staging Categories

T describes the primary tumor. It tells us the size of the tumor and whether it has grown into nearby areas.

TX: Cannot assess primary tumor
T0: No evidence of primary tumor
T1: Tumor 7.0 cm (about 2.8 inches) or less, only in the kidney
T1a: Tumor 4.0 cm (about 1.6 inches) or less, only in the kidney
T1b: Tumor 4.0-7.0 cm, only in the kidney
T2: Tumor greater than 7.0 cm, only in kidney
T2a: Tumor greater than 7.0 cm and less than 10.0 cm, only in the kidney
T2b: Tumor greater than 10 cm (about 3.9 inches), only in the kidney
T3: Tumor grows into major veins but not into the adrenal gland and not beyond the tissue around the kidney's and adrenal glands
T3a: Tumor involves the renal vein or its branches, or perirenal and or renal sinus fat but does not grow beyond the tissue that go around the kidneys and adrenal glands
T3b: Tumor grows into the large vein that brings blood into the heart and below the diaphragm
T3c: Tumor grows into vena cava above diaphragm or reaches into the diaphragm
T4: Tumor reaches beyond the tissue around the kidney's and adrenal glands

N - This category describes the regional lymph nodes
NX: Cannot assess regional nodes
N0: No regional lymph node metastasis
N1: Metastasis in regional lymph node(s)

M - This category describes distant metastases
M0: No distant metastasis
M1: Distant metastasis