Staging and prognosis for kidney cancer

Once you have had tests that show you have kidney cancer, your doctor will work out the stage and grade of the cancer.

The stage describes how far the cancer has spread, while the grade describes how active the cancer cells are and how fast the cancer is likely to be growing. Staging and grading help the doctor decide on the best treatment for you.

The expected outcome of your disease is called the prognosis, but it is only a prediction and some people do not find it helpful or even prefer not to know.

Learn more about:

• Grading kidney cancer
• Staging kidney cancer
• Prognosis

Grading 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.
• 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.

Staging kidney cancer

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).

If you have kidney cancer, your doctor will use the results of these tests to assign a stage of 1 to 4:

• stages 1–2 are considered early kidney cancer
• stages 3–4 are considered advanced kidney cancer.

How kidney cancer is staged

In Australia, the TNM system is the method most often used for staging kidney cancer. The 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).

Prognosis

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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