Stage 4 Kidney Cancer: Understanding the Prognosis

While kidney cancer isn’t the most common or deadliest type of cancer, developing it is a risk that everyone should be aware of as they grow older. For both men and women, kidney cancer ranks as one of the 10 most common cancers. According to the American Cancer Society, a man has a one in 48 chance of getting kidney cancer during his lifetime, while a woman’s risk is one in 83. In 2020, an estimated 73,750 new cases of kidney cancer will be diagnosed and nearly 15,000 people died from the disease.

Kidney cancer rates have been growing over the past 20 years, and it’s not exactly clear why. One possibility is that increased use of technology like CT scans may be helping doctors find kidney cancer cases that they wouldn’t have seen before, the American Cancer Society says.

How kidney cancer is staged

Like many other types of cancer, kidney cancer is ranked in stages based on its severity. The smallest and least advanced forms of kidney cancer are stages 0 and 1, and the most advanced is stage 4.

To determine the stage of kidney cancer, a doctor may use a system, known as TNM, that looks at three key pieces of information: the size of the kidney cancer tumor (T), whether the cancer has spread to any lymph nodes (N) and whether the cancer has metastasized (M), meaning it has spread to other organs in the body.

Defining stage 4 kidney cancer

There are certain defining factors that can classify a case of kidney cancer as stage 4. One is that the tumor has to be large — a T4 — in order to be defined as stage 4. A T4 tumor is so large that it has spread outside the kidney itself. The kidney is surrounded with a fibrous layer known as Gerota’s fascia, and when the tumor has spread past the Gerota’s fascia and into the adrenal gland, this meets the qualifications of stage 4 kidney cancer, the American Cancer Society says.

The other standard that will classify a case of kidney cancer as stage 4 is the presence of the cancer in other organs — an M score of M1. Whenever the cancer spreads beyond the kidneys to other organs, or to lymph nodes that are far away from the kidneys, this indicates stage 4 cancer.

The risks of kidney cancer

When it comes to the prognosis and life expectancy of the various stages of kidney cancer, the numbers become more concerning as the stage of cancer increases. In general, kidney cancer primarily affects older people. The average age when a kidney cancer diagnosis occurs is 64, and it’s unlikely for people younger than 45 to be diagnosed with kidney cancer, according to the American Cancer Society.

When kidney cancer does occur, the survival rate is much higher if the cancer is detected and treated early than if it happens later in the cancer’s development. If kidney cancer is still in stage 1 or stage 2, this is sometimes called a localized stage cancer because the cancer remains within the kidney. The five-year survival rate at this point is quite high, at 93 percent.

However, when the stage of the cancer transitions from stages 1 and 2 to stages 3 and sometimes 4, in the form of regional cancers, survival options begin to shift a bit. For these so-called regional forms of kidney cancer, the five-year survival rate is now 69 percent. Distant cancers — those that have spread to more distant parts of the body — are all stage 4 and have the worst prognosis: The survival rate after five years with these forms of cancer is 12 percent.

Understanding kidney cancer survival rates

With five-year survival rates ranging from about 69 percent for regional forms of stage 4 kidney cancer to 12 percent for distant stage 4 cancer, it’s understandable to be alarmed about a stage 4 kidney cancer prognosis. However, it’s also important to understand that other factors are involved in these rates. For example, the American Cancer Society notes that treatments are improving all the time, so these numbers are likely to be better now than the last time statistics were documented. In addition, these rates only represent life expectancy for the cancer when it’s first diagnosed. Survival rates also tend to be better in general among younger, healthier people, who respond better to treatment, than among those who are older and more frail.

Other factors can also affect someone’s life expectancy with stage 4 kidney cancer. For example, people with high blood calcium levels, those with high blood lactate dehydrogenase (LDH) levels and people with anemia may have a greater risk of fatality from stage 4 kidney cancer. Other risk factors include cancer that has spread to two or more distant sites or a cancer that needs treatment like targeted therapy, chemotherapy or immunotherapy less than a year after diagnosis.

Treating stage 4 kidney cancer

According to the Mayo Clinic, kidney cancer that advances to stage 4 may not be curable. But that doesn’t mean that there isn’t room for hope for those with stage 4 cancer. For starters, there are several different types of treatment options available. And many are effective at controlling the cancer, limiting its spread and improving overall quality of life.

Options may include:

• Surgery: Even if the cancer has spread to other parts of the body, surgery to remove the cancerous kidney and other cancer from the body, when possible, can be an important first step. If surgery is not possible, tumor embolization — a procedure where the blood supply to the tumor is cut off — may be used in some cases.
• Radiation: Radiation therapy can shrink tumors and kill cancer cells all over the body. This makes it useful for reducing symptoms and slowing the spread of cancer.
• Targeted therapy: Targeted therapies are a unique and growing treatment option for kidney cancer. Some targeted therapies may prevent kidney cancer cells from multiplying by blocking the signals that lead to their growth.
• Biological therapy or immunotherapy: Biological therapies are treatments that use the body’s immune system or synthetic chemicals similar to those in the immune system to attack the cancer cells.
• Clinical trials: New and ongoing trials that are testing new methods of treating stage 4 kidney cancer may also be available. You can ask your doctor about these opportunities.

Stage 4 kidney cancer coping & support

There’s no question that dealing with a stage 4 cancer diagnosis can be challenging, which is why knowing your options for coping and support is so important.

People can take care of themselves during this challenging time by eating a healthy diet, getting plenty of sleep and staying active when they’re feeling up to it. Staying educated about your disease in order to make the right decisions about your health is important, as is forming a support network of friends and family who can help you out when you need it. Many people need mental and emotional support when going through a challenging illness such as stage 4 kidney cancer. Support groups, psychologists or other forms of therapy can all be helpful for coping and support.