Metastatic Stage 4 Kidney Cancer

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

Stage 4 kidney cancer is an advanced form of the disease. It means that cancer has either begun to spread outside the kidney into the adrenal gland area or that cancer has spread to distant organs. It may also be called Stage 4 renal cell cancer.

Between 2015 and 2021, about 15% of people diagnosed with kidney cancer were diagnosed in an advanced stage after cancer had already spread (metastasized) to distant areas of the body.

What Is Stage 4 Kidney Cancer?

Stage 4 kidney cancer occurs when the cancer has spread outside of the kidney to a distant body site.

Kidney cancer stages are based on the American Joint Committee on Cancer’s TNM system. Each letter stands for a piece of information that helps doctors understand the extent of the cancer.

T stands for tumor. This letter describes the tumor’s size and where it has grown.

N stands for nodes. This letter describes whether the cancer has spread to nearby lymph nodes.

M stands for metastasis. This letter describes whether the cancer has spread to distant organs.

Numbers or letters after T, N or M provide more information. Higher numbers mean the cancer is more advanced or has affected more areas.

Stage 4 Kidney Cancer Criteria

Kidney cancer must have either of the following sets of characteristics to be considered Stage 4.

One set of characteristics is referred to as T4, any N, M0.

T4: The tumor is growing beyond the tissue that covers the kidney, possibly into the adrenal gland above the affected kidney.

Any N: It may have spread to nearby lymph nodes, but not necessarily.

M0: It has not spread to distant lymph nodes or organs. 

Another set of characteristics is referred to as any T, any N, M1.

Any T: The tumor could be any size.

Any N: It may have spread to nearby lymph nodes, but not necessarily.

M1: It has spread to distant lymph nodes or other organs.

Kidney cancer is considered Stage 4 if it meets all the criteria in either of these characteristic sets.

Where Does Metastatic Kidney Cancer Spread?

As kidney cancer grows, it tends to grow outward to the thin tissue that surrounds the kidney called Gerota’s fascia. The next organ that may be affected is the adrenal gland that sits directly above the kidney or the nearby lymph nodes.

Once cancer moves beyond the immediate area, it tends to spread to distant lymph nodes and the lungs, liver, brain and bones.

Stage 4 Kidney Cancer Symptoms

In early stages, kidney cancer tends to have no symptoms. Symptoms might start when the cancer continues growing and affects other organs.

Experiencing any of these symptoms does not necessarily mean cancer is the cause. Many of these overlap with those of other conditions, such as kidney stones, or bladder or urinary tract infections. Anyone with these symptoms should talk to a doctor about them to determine the cause. 

Some symptoms of kidney cancer in the advanced stage may include:

• Blood in the urine (hematuria)
• Unexplained weight loss
• Fatigue
• Loss of appetite
• A lump in the back or side
• Pain or pressure in the back or side
• Ankle or leg swelling
• High blood pressure
• Anemia (low red blood cell count)
• Enlarged veins around a testicle (varicocele)
• Fever that does not go away and is not from a cold, flu or other infection

For Stage 4 kidney cancer, managing symptoms is an important part of the treatment plan. Comfort and specialized care help patients with metastatic kidney cancer cope with and manage pain and other symptoms during and after treatment. Managing symptoms is typically referred to as palliative and supportive care, and it is provided by the patient’s care team.

Stage 4 Kidney Cancer Treatment

Cancer treatment plans are individualized, taking into account the patient’s overall health, how much the cancer has spread and the patient’s preferences. Treatment plans should provide comprehensive care that not only treats the cancer, but also prioritizes the patient’s well-being.

For Stage 4 kidney cancer that has not spread far beyond the kidneys, surgery or radiation therapy may be treatment options. Surgery removes the tumor and areas where the cancer has spread, possibly followed by a year of adjuvant therapy with pembrolizumab (Keytruda^®), an immunotherapy drug. Radiation therapy for the area the cancer has spread may be an option, too. Surgery or radiation therapy might also help manage symptoms such as bone pain or trouble breathing caused by cancer that has spread to other areas of the body.

Systemic therapy uses drugs to treat cancer throughout the body, instead of only targeting the main tumor. Two types of systemic therapy — immunotherapy and targeted therapy drugs — are typically the main treatment for kidney cancer that has spread beyond the kidneys. 

• Immunotherapy helps the immune system recognize and destroy cancer cells.
• Targeted therapy works to shut down proteins and genes in cancer cells that help them grow, make cells die off sooner, or sometimes destroy cancer cells.

These are either given intravenously through an IV tube or as medication taken by mouth like a pill or a capsule.

Patients with Stage 4 kidney cancer may be treated with some combination of these drugs, such as:

• Two immunotherapy drugs
• One targeted therapy drug
• One targeted therapy drug and one immunotherapy drug

Advanced kidney cancer may be hard to treat, but experts have found some combinations of drugs to be more helpful than others.

These combinations include:

• Ipilimumab (Yervoy^®) with nivolumab (Opdivo^®)
• Axitinib (Inlyta^®) with pembrolizumab (Keytruda^®)
• Cabozantinib (Cabometyx^®) with nivolumab (Opdivo^®)

Many additional systemic drug combinations are available as well.

Advanced kidney cancer is sometimes challenging to treat. That’s why experts continue to explore the value of systemic treatments for advanced kidney cancer in clinical trials. Patients also have the option of joining a clinical trial that is testing new combinations of drug therapies and other new treatments for metastatic kidney cancer.

Pain management and palliative care to manage symptoms and side effects of treatment are an essential aspect of a treatment plan as well.

Stage 4 Kidney Cancer Survival Rate

Survival rates help explain what percentage of people are likely to be alive five years after their diagnosis. They are based on a large set of patients in the past with the same diagnosis. However, they cannot predict what will happen with any one patient.

The five-year relative survival rate for advanced kidney cancer (and renal pelvic cancer) that has spread beyond the area of the kidneys is 19.1%, according to the National Cancer Institute.

This number is based on people diagnosed between 2015 and 2021, so it does not necessarily represent the survival rate today. Cancer survival rates tend to change over time due to advances in cancer treatment.