Kidney Cancer Diagnosis and Staging

January 7, 2026

This page was reviewed under our medical and editorial policy by Walter Stadler, M.D., professor, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Chicago

A variety of tests are used to diagnose kidney cancer. If a cancer diagnosis is made, additional tests help doctors determine the cancer’s stage, which is a measure of its size and whether it has spread to other areas of the body. 

This guide is designed to help patients and their families learn more about kidney cancer diagnosis and staging.

How Is Kidney Cancer Diagnosed?

If a patient’s health care team suspects that kidney cancer may be present, or if the patient has noticed potential kidney cancer symptoms, doctors perform a series of tests to find out more.

Tests used for kidney cancer diagnosis and staging include the following.

Physical examination: During a physical examination, a doctor reviews a patient’s medical history and looks for any signs or symptoms of the disease.

Blood tests: While blood tests play an important role in understanding a patient’s health, on their own they are not enough to confirm a cancer diagnosis. But abnormalities on these blood count tests — particularly red blood cell count, liver enzyme or blood calcium readings — may be indicative of kidney cancer.

Urine lab tests: Since the kidneys play a key role in urine production, testing urine may help doctors learn more about how they are functioning. A sample of urine is obtained and tested, looking for the presence of cancerous or precancerous cells or biomarkers indicating kidney cancer.

Biopsy: A biopsy is the only way to confirm a diagnosis of kidney cancer. It is generally an outpatient medical procedure. The patient is given local anesthesia so there is no discomfort, and then a small tissue sample is surgically removed for examination under a microscope to look for the presence of cancer cells.

If kidney cancer is found, additional testing may be performed to learn more about the cancer’s stage and type. These additional tests may include the following.

Computed tomography (CT or CAT) scan: A series of X-ray images are taken at different angles to form a computer-generated image that determines tumor size, location and the number of tumors within the body. A contrast dye is used so the images provide more detail. CT scans may also be used to guide a biopsy or determine if the cancer has spread.

Magnetic resonance imaging (MRI): This procedure uses a powerful magnet, radio waves and a computer to create an image of the kidneys. A special dye called contrast medium may be injected to create clearer images. MRI may also be used to guide a biopsy and to check for cancer spread into other areas, particularly the blood vessels.

Ultrasound: High-energy sound waves are used to create images of the kidney, and they may also be used to guide a biopsy. Ultrasounds are useful in determining if a mass in the kidney is solid or filled with liquid.

Bone scan: This procedure uses an injection of a small amount of radioactive material to determine if kidney cancer cells have spread to the bones. The radioactive material shows up brightly on an imaging scan when it attaches to abnormal cells, allowing doctors to see where the cancer is located.

Chest X-ray: Because the lungs are a common site for kidney cancer’s spread, a chest X-ray may be used to see if the disease has metastasized (spread). However, CT scans are more often used for this purpose.

Genomic testing: Genomic testing looks at features inside the cancer’s cells. This laboratory test helps to identify certain genetic mutations, which may predict how fast a cancer is growing and to create each patient's treatment plan. It is also referred to as biomarker or tumor testing, and it is performed on a biopsy or blood sample.

Together, these tests allow doctors to better understand a patient’s health and recommend a personalized kidney cancer treatment plan.

Kidney Cancer Screening

There is no routine screening program for kidney cancer. Instead, patients with an increased lifetime risk for developing the disease should receive closer monitoring, experts advise. This includes those who have a family history of kidney cancer or known risk factors for the disease, such as high blood pressure, obesity and tobacco use.

Patients with a higher than average risk may wish to speak to their doctor about more frequent appointments because regular imaging, including CT scans and ultrasounds, may be recommended to look for early stages of cancer.

Kidney Cancer Stages

Each kidney cancer is staged based on its type, size, location and whether it has spread to other areas of the body. The most common staging method is the TNM system, which provides a stage for each cancer, ranging from Stage 1 to 4. It is based on three factors:

• T stands for tumor, with doctors identifying the tumor’s size and whether or not it has spread.
• N represents the lymph nodes and if the cancer has spread into them.
• M stands for metastasis, meaning whether the cancer has spread into other areas of the body.

Together, these factors create a stage for each patient’s cancer.

Stage 1 Kidney Cancer

Stage 1 kidney cancer is confined to the kidneys and has not spread into any other organs. It is less than 7 centimeters in size. Stage 1 cancers may be categorized further into the stage groupings listed below. 

T1a: The tumor is confined to the kidney and is less than 4 centimeters in size.

Tlb: The tumor is confined to the kidney and is 4 to 7 centimeters.

Stage 2 Kidney Cancer

In Stage 2, the cancer is still confined within the kidneys and has not spread elsewhere. However, it is larger than 7 centimeters. Stage 2 cancers may be broken into T2a and T2b stage groupings, as detailed below.

T2a: The tumor is confined to the kidney and is between 7 and 10 centimeters.

T2b: The tumor is confined to the kidney and is larger than 10 centimeters.

Stage 3 Kidney Cancer

Stage 3 tumors have spread to nearby tissues and veins, and may or may not be found in nearby lymph nodes. There is no spread to distant organs. A cancer may also be considered Stage 3 if it has spread to nearby lymph nodes, but not elsewhere. Stage 3 cancers may be categorized into the following groupings.

T3a: The tumor has spread out of the kidney, but not past Gerota’s fascia, connective tissue on the outside of the organs. T3a cancer has spread into the renal vein or its branches and/or to the kidney’s calyces (where urine collects before moving to the bladder) or the pelvis.

T3b: The cancer has spread into the inferior vena cava. This is a large vein below the diaphragm that transports blood to the heart.

T3c: Tumors have also spread into the inferior vena cava, as well as into its walls or into the heart.

Stage 4 Kidney Cancer

Stage 4 is the highest stage of kidney cancer. It has spread into distant areas of the body, which may include the brain, lungs or bones. 

Learn more about Stage 4 metastatic kidney cancer