Stage 4 Renal Cell Carcinoma (2024)

Stage 4 kidney cancer is the most advanced type of cancer that has developed in the kidneys and then spread to other organs in your body. Your treatment plan and outlook depend on several factors.

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The kidneys are two fist-sized organs on either side of your spine beneath your ribcage. They’re responsible for filtering waste products and fluid from your blood, which then get flushed out in your urine.

The American Cancer Society (ACS) estimates that nearly 82,000 people in the United States will receive diagnoses of kidney cancer in 2024.

Renal cell carcinoma (RCC) is a type of cancer that accounts for 90% of kidney cancers, according to the ACS. RCC, also called renal cell cancer or renal cell adenocarcinoma, usually grows as one tumor in one kidney.

But sometimes, more than one tumor may grow in one or both kidneys.

In some cases, RCC may also spread to other parts of the body. This occurs during stage 4 of kidney cancer, which is the last and most advanced stage.

RCC begins in one or both of your kidneys as a tumor.

The tumor may then spread into the surrounding tissues or other parts of your body.

There are two ways RCC could spread through your body:

  1. Local: This is when your tumor has spread to nearby veins and tissues, such as lymph nodes and blood vessels. This type is also called advanced RCC.
  2. Metastasis: This is when cancer has spread outside of your kidney to other parts of your body, such as the lungs, bones, and brain.

How the cancer spreads will help determine the stage of cancer you’re in and your treatment plan.

The different stages of kidney cancer may help you understand the current state, future outlook, and possible treatment plans for the cancer.

The American Joint Committee on Cancer developed a three-letter staging and scoring system called TNM:

  • T (tumor): Size and growth of the main kidney tumor.
  • N (node): If the cancer has spread to any nodes in the lymph system.
  • M (metastasis): If the cancer has spread to other parts of the body.

Based on your TNM score, a doctor will assign a numbered RCC stage. These stages are based on the tumor’s size and how far the cancer has spread.

There are four stages:

  • Stage 1: The tumor is smaller than 7 centimeters (cm) and is still in the kidney.
  • Stage 2: The tumor is larger than 7 cm but is still in the kidney.
  • Stage 3: The tumor has spread into a major vein, nearby tissue, or lymph nodes.
  • Stage 4: The cancer has spread to the adrenal gland or has spread to distant lymph nodes or other organs. This is the most advanced stage of kidney RCC.

The outlook for stage 4 RCC is different for each person.

The ACS reports the estimated survival rate for people who live 5 years or more after their initial RCC diagnosis. These statistics are based on Surveillance, Epidemiology, and End Results (SEER) data from the National Cancer Institute.

The ACS uses a three-stage system to report survival rates:

StageDefinition5-year survival %
localizedcancer has not spread beyond the kidney93%
regionalcancer has spread nearby, such as to structures of lymph nodes74%
distantcancer has spread to distant parts of the body, such as the brain or bones17%

Stage 4 RCC falls within the distant stage.

That said, remember that these survival rates are only estimates.

People now receiving diagnoses of RCC may have better survival rates because treatment methods continue to advance.

A doctor will also make a diagnosis, provide an outlook, and create a treatment plan based on other factors.

Treatment for stage 4 RCC depends on the location and metastasis of the cancer, as well as your overall health.

Your treatment plan may include surgery, systemic therapies, or treatments being developed in clinical trials.


Surgery for RCC is more common in stages 1, 2, and 3 because it’s easier to isolate the tumor. For stage 4 kidney cancer, it may not make sense to do surgery.

When cancer has spread, it’s usually not beneficial to remove the tumors by surgery. Even removing the primary tumor has not been shown to yield benefits in most cases.

That said, if surgery is still possible in your case, you may have a cytoreductive nephrectomy to help lower your pain or prolong your life. This involves surgically removing most or all of the affected kidney.

Systemic therapies

If surgery isn’t a realistic option to treat stage 4 RCC, a doctor may recommend a combination of medications.

First, a sample of your tumor, called a biopsy, will be obtained to determine whether you have clear cell or non-clear cell RCC. This will help determine the best treatment plan for you.

Then, a doctor may prescribe targeted therapy, which can involve taking medications like:

  • tyrosine kinase inhibitors
  • angiogenesis inhibitors
  • mammalian target of rapamycin (mTOR) kinase inhibitors

Or they may recommend immunotherapy, which may involve:

  • checkpoint inhibitor therapy such as pembrolizumab (Keytruda) and nivolumab (OPDIVO)
  • cytokine therapy

Clinical trials

New treatments may be available through clinical trials. You can discuss enrolling in a clinical trial with a doctor.

A healthcare professional may also recommend supportive treatments to help with any side effects or symptoms.

How long can you live with stage 4 renal cell carcinoma?

It’s hard to know how long someone is going to live with stage 4 cancer because it depends on many factors.

According to the ACS, the 5-year survival rate for people with stage 4 kidney cancer is 17%. This reflects the number of people who are still alive after 5 years of their RCC stage 4 diagnosis.

What is the best treatment for renal cell carcinoma stage 4?

There is no “best” treatment for renal cell carcinoma stage 4. According to the National Cancer Institute, the first-line treatment for stage 4 renal cancer depends on the exact spread and size of the tumor. It’s usually a combination of one or more medications:

  • nivolumab (OPDIVO)
  • Ipilimumab (Yervoy)
  • cabozantinib (Cometriq, Cabometyx)
  • pembrolizumab (Keytruda)
  • axitinib (Inlyta)
  • lenvatinib (Lenvima)
  • avelumab (Banvencio)
  • sunitinib (Sutent)
  • pazopanib (Votrient)
  • sorafenib (Nexavar)
  • temsirolimus (Toricel)
  • bevacizumab (Avastin)
  • interferon-alpha (Roferon–A, IntronA, Pegintron, PEGASYS)
  • interleukin-2 (IL-2, Aldesleukin, PROLEUKIN)

In some cases, you may also need a nephrectomy or a type of radiation called palliative external-beam radiation therapy (EBRT).

Can stage 4 kidney cancer go into remission?

While complete remission isn’t impossible, there isn’t enough data to suggest it’s common.

Treatment for stage 4 kidney cancer will depend on the size of your tumor and what other parts of your body are affected. A typical treatment plan may include surgery, systemic therapies, and clinical trials.

Is stage 4 cancer terminal?

Stage 4 cancer is the most advanced stage and requires intense treatment. That said, it’s not always terminal.

For example, 17% of people with stage 4 kidney cancer live for 5 years after their diagnosis.

Stage 4 kidney cancer is when the tumor(s) in your kidney has spread to other parts of your body, such as your lungs, brain, or bones.

If you’ve received a diagnosis of stage 4 RCC, it’s important to note that the published survival rates are estimates.

Your individual outlook depends on several factors, like the type of cancer and how far it has advanced, your response to treatments, and your overall health.

It’s key to follow your care team’s advice, go to your appointments, and take your medications. Follow through with any treatment suggestions or lifestyle changes to address side effects and symptoms. This can help support your overall health and well-being during treatment.

Stage 4 Renal Cell Carcinoma (2024)
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