Last updated: 15-Oct-2026
Dr Swati Shah
MS, DrNB (Surgical Oncology)
Kidney Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ 4.99 from 84 Google reviews (Gota clinic) · 5.0 from 35 (Apollo, Bhat)
IN SHORT
The stage says how far the cancer has gone: its size, whether it has reached the fat or a vein, and any spread to nodes or organs.
Stages I and II are still inside the kidney. Stage III has reached the fat, a large vein or nearby nodes. Stage IV has gone further.
When kidney cancer has spread, a separate risk group, called IMDC, is worked out from six simple checks. It guides the choice of medicine.
Kidney cancer is staged with the TNM system. T is the tumour, N the lymph nodes and M spread to distant organs. The stage is first set on the CT scans. It is confirmed after the operation, when the removed tissue is examined.
| Stage | What it means | Usual plan |
|---|---|---|
| I | Confined to the kidney. Up to 4 cm is T1a, and 4 to 7 cm is T1b. | Removing only the tumour (partial nephrectomy) is preferred. A small tumour in a frail person may be watched or treated by ablation. |
| II | Larger than 7 cm, still confined to the kidney. | Removing the whole kidney (radical nephrectomy). Partial removal where it is possible. |
| III | Grown into the fat around the kidney, into the kidney vein or the main body vein, or into nearby nodes. | Radical nephrectomy, with removal of any vein clot. Medicine after surgery is discussed. |
| IV | A T4 tumour, grown beyond the layers around the kidney, or spread to distant organs. | Medicines first, with kidney removal or removal of a few deposits for selected people. |
For a tumour of 4 cm or less, saving the kidney is the standard. Watching or ablation suits some people. Removing the whole kidney is not done for this size here.
Some kidney cancers grow a finger of tumour into the kidney vein. It can reach the main vein that carries blood to the heart. The level of this clot is mapped on CT or MRI before surgery. Level I sits in the kidney vein or just enters the main vein. Level II stays below the liver. Level III reaches behind the liver. Level IV goes above the diaphragm, towards the heart. Levels III and IV are planned with heart and blood-vessel surgeons, with the heart-lung machine kept ready. This is never an unplanned operation.
Two tumours of the same stage can behave differently. The histology report adds grade, type and other features that change the follow-up and the advice.
| Feature | What it tells you |
|---|---|
| Grade (WHO/ISUP). | How abnormal the cells look. A higher grade is more aggressive. |
| Sarcomatoid or rhabdoid change. | A major warning sign. It is recorded and acted on. |
| Tumour necrosis. | Dead areas inside the tumour, another sign of more aggressive disease. |
| Type of kidney cancer. | Clear cell, papillary and chromophobe behave differently and respond to different medicines. |
The risk of the cancer coming back is then judged with a validated score, such as Leibovich or UISS. It is more accurate than the stage alone. This score also sets how often scans are done after surgery.
After a clear cell cancer is fully removed, one medicine has shown a survival benefit. It is pembrolizumab, an immunotherapy given every 3 weeks for about a year. It is offered when the risk of return is raised. That means a stage II tumour of grade 4 or with sarcomatoid change, any stage III or T4 tumour, nodes involved, or spread that was fully removed. Other medicines tried after surgery did not help, so tablets like sunitinib are not offered for this. Pembrolizumab is costly and is rarely covered by insurance in India. It is still offered and discussed openly, with patient-assistance options checked.
For stage IV, the IMDC risk group is worked out before the first dose of medicine. It counts six simple factors from your health and blood tests.
| Factors present | Risk group | What it guides |
|---|---|---|
| None. | Favourable. | Immunotherapy combinations are advised. Tablets like sunitinib or pazopanib are also acceptable. |
| One or two. | Intermediate. | Immunotherapy combinations. Cabozantinib tablets if immunotherapy cannot be given. |
| Three or more. | Poor. | Medicines, not kidney removal. Cabozantinib if immunotherapy cannot be given. |
Immunotherapy combinations are out of financial reach for many families here. Tablets such as sunitinib, pazopanib and cabozantinib, including generics, are then the usual first treatment. The guideline option is still offered and the decision is recorded. Removing the kidney is no longer routine in stage IV. It suits people who are fit, in the favourable or lower intermediate group, with little spread, or with a bleeding or painful kidney. A few deposits, especially in the lung, may be removed in a fit patient.
Not always. Small tumours in frail people may be watched with scans or treated by ablation. For most fit people, removing only the tumour is preferred.
Yes. The scan gives a first stage. The removed tissue confirms it, and may show fat or vein involvement that scans missed.
The cancer has grown into the kidney vein or the main body vein. It is stage III, and its level decides how the operation is planned.
It is a score used when kidney cancer has spread. Six health and blood factors sort people into favourable, intermediate or poor groups, which guide medicine choice.
Most people need regular scans only. Pembrolizumab is offered after clear cell cancer when the risk of return is raised, such as stage III.
How the operation is chosen is on the partial or whole kidney removal page. The first signs are on how kidney cancer shows itself. For questions, call +91-63590-11009.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Swati Shah — MS, DrNB (Surgical Oncology) · Kidney Cancer Surgeon
Consultation: Gota OPD, Gota, Ahmedabad. Surgery: Apollo Hospital, Bhat, Gandhinagar.
Gota OPD — Gota, Ahmedabad, Gujarat
Apollo Hospital, Bhat, Gandhinagar — Apollo Hospital International Limited, Plot No. 1 A, GIDC Bhat Industrial Estate, Bhat, Gandhinagar, Gujarat
Call: +91-63590-11009 · WhatsApp: +91-63590-11009
Have a CT report or a histology report that gives a stage? Send it ahead on WhatsApp, so the visit starts with it read. What the stage means for your treatment is decided at the consultation, after examination. Call +91-63590-11009 Send your reports before the visit
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