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The grading, staging and prognosis of kidney cancer


By examining under a microscope a tissue sample taken during a biopsy or after surgery, doctors can see how similar the cancer cells look to normal cells and estimate how fast the cancer is likely to be growing. This is called grading. It helps the doctors decide what follow-up treatment you might need and whether to consider a clinical trial.

There are different systems for grading kidney cancer. The Fuhrman system has been widely used in Australia, but a newer system called the International Society of Urological Pathology (ISUP) system has been introduced. Both systems grade kidney cancer from 1 to 4, with grade 1 being the slowest growing and grade 4 the fastest growing.


The stage of a cancer describes how large it is, where it is, and whether it has spread in the body. Knowing the stage of the kidney cancer helps doctors plan the best treatment for you. The stage can be given before surgery (clinical staging), but may be revised after surgery (pathologic staging).

In Australia, the TNM system is the method most often used for staging kidney cancer. TNM stands for tumour–nodes–metastasis. This system gives numbers to the size of the tumour (T1–4), whether or not lymph nodes are affected (N0 or N1), and whether the cancer has spread or metastasised (M0 or M1). Based on the TNM numbers, the doctor then works out the cancer’s overall stage (1–4).

  • stages 1–2 are considered early kidney cancer
  • stages 3–4 are considered advanced kidney cancer.
Stage 1The cancer is confined to the kidney and measures less than 7 cm.
Stage 2The cancer is larger than 7 cm, may have spread to the renal vein or the outer tissue of the kidney, but no further, and has not spread to any lymph nodes.
Stage 3The cancer is any size and has spread to nearby lymph nodes, or the cancer has spread to the adrenal gland.
Stage 4The cancer has spread beyond the kidney, adrenal gland and nearby lymph nodes, and is found in more distant parts of the body, such as the abdomen, distant lymph nodes, or organs such as the liver, lungs, bone or brain.


Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for anyone to predict the exact course of the disease. Your doctor can give you an idea about common issues that affect people with kidney cancer.

The stage of the cancer is the main factor in working out prognosis. In most cases, the earlier that kidney cancer is diagnosed, the better the chance of successful treatment. If the cancer is found after it has spread to other parts of the body, it is very unlikely that all of the cancer can be removed, but treatment can often keep it under control.

People who can have surgery to remove kidney cancer tend to have better outcomes. Other factors such as your age, general fitness and medical history also affect prognosis.

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Understanding Kidney Cancer

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This information is reviewed by

This information was last reviewed November 2020 by the following expert content reviewers: A/Prof Daniel Moon, Urologic Surgeon, Australian Urology Associates, and Honorary Clinical Associate Professor, The University of Melbourne, VIC; Polly Baldwin, 13 11 20 Consultant, Cancer Council SA; Ian Basey, Consumer; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; Tina Forshaw, Advanced Practice Nurse Urology, Canberra Health Services, ACT; Dr Suki Gill, Radiation Oncologist, Sir Charles Gairdner Hospital, WA; Karen Walsh, Nurse Practitioner, Urology Services, St Vincents Private Hospital Northside, QLD; Dr Alison Zhang, Medical Oncologist, Chris O’Brien Lifehouse and Macquarie University Hospital, NSW.