What Happens When Kidney Cancer Spreads?

Kidney cancer is one of the most common cancer types among men and women in the United States, affecting around 1 in 46 men and 1 in 80 women¹ over their lifetime. Kidney cancer affects more men than women and is more often diagnosed in adults between the ages of 65 and 74¹. The most common type of kidney cancer is renal cell carcinoma (RCC), which accounts for around 90% of diagnosed kidney cancers.

If caught early, kidney cancer is usually treatable. However, once it spreads, your treatment options may become limited. 

Learn more about kidney cancer, how it spreads, and what happens once that spread begins. 

What are the stages of kidney cancer?

When diagnosed with cancer, your doctor may tell you what stage your cancer is at. The stage will classify your current condition and guide your treatment options going forward. There are four stages of kidney cancer:

• Stage I: The tumor is smaller than seven centimeters and is isolated in the kidney

• Stage II: The tumor is larger than seven centimeters and is isolated in the kidney 

• Stage III: The tumor has spread to lymph nodes, blood vessels, or other tissues near the kidney

• Stage IV: The tumor has spread to other areas or organs of the body, such as the brain, lungs, or bones

How does kidney cancer spread?

Kidney cancer most often starts in the tubules, tiny tubes within the kidneys. As cancer cells within the tubules grow and multiply, they can spread into nearby tissues. Once there, cancer can start to invade the walls of nearby lymph nodes and blood vessels. Cancer cells can then spread to other areas as they travel through the lymphatic system and the bloodstream.

Usually, cancer cells will die as they spread - this is why cancer doesn't always metastasize. However, when the conditions are right, cancer cells can invade tissue, such as blood vessel walls. Here, they can create a tiny tumor.

If that small tumor has a blood supply, it can continue growing and spreading. 

Where is kidney cancer most likely to spread?

While kidney cancer can spread to any body area, it tends to appear more commonly in certain areas, for example: 

• Lungs (45% of cases)

• Bones (30% of cases)

• Liver (20% of cases)

• Pancreas (10% of cases)

• Brain (9% of cases)

How likely is it that kidney cancer will spread?

The likelihood that kidney cancer will spread depends on several factors, including your overall health and age. The most decisive determining factor is the type of kidney cancer, as some types grow and spread more quickly than others. 

The most common type of kidney cancer is renal cell carcinoma (RCC), accounting for around 90% of kidney cancers. There are roughly a dozen subtypes of RCC. Out of all RCC diagnoses, about 80%² are clear cell renal cell carcinoma (ccRCC) subtypes. This form of kidney cancer grows quickly, with around one-third of cases already metastasizing³ by the time of diagnosis.

Other subtypes, such as collecting duct RCC and medullary RCC, only occur in about 1% of all kidney cancer cases⁴, but these are very aggressive and can metastasize quickly. 

When you are diagnosed with kidney cancer, you'll want to ask your doctor what stage the cancer is at and the name of the type of kidney cancer you have. They can offer guidance on your specific risk of cancer metastasizing.  

What symptoms indicate the cancer is spreading?

People in the early stages of kidney cancer may not experience any symptoms of the disease. A lack of symptoms is why roughly one-third of patients diagnosed with kidney cancer⁵ are in stage III or stage IV when the cancer has metastasized. Doctors may discover kidney cancer during routine screening or imaging for other health concerns.

Once cancer starts spreading, you are more likely to begin noticing symptoms.

Some of the symptoms you may experience once cancer has spread can include: 

• Blood in the urine

• Pain or a lump in your flank

• Feeling more tired than usual

• Unexplained loss of appetite

• Unexplained weight loss

• Recurring fever

• Swelling in your ankles and legs

If you experience these symptoms, you should visit your primary care physician. While many of these symptoms may be associated with other, less severe conditions, getting checked is crucial. Being proactive about your symptoms could help you get earlier treatment, improving your potential outcomes. 

What are the treatment options once kidney cancer spreads?

There are more treatment options for kidney cancer in the earlier stages. As cancer spreads, there may be fewer options, depending on how quickly it spreads and where it spreads.

Sometimes, treatment is no longer an option for kidney cancer. This is called advanced kidney cancer. Advanced kidney cancer may happen once cancer spreads to other areas of the body, making it inoperable, or if it is an aggressive form of kidney cancer that doesn't respond well to treatment. In these cases, your medical team will work with you to keep you as comfortable as possible for as long as possible. 

Common treatment options for kidney cancer include surgery, targeted therapy, immunotherapy, and radiation. Chemotherapy isn't often used to treat kidney cancer, as most forms are resistant to chemotherapy's effects.

Surgery

Surgery may involve removing the tumor and all or part of the affected kidney and the surrounding tissues. How much of your kidney and surrounding tissue the doctor chooses to remove will depend on how aggressively your cancer spreads and where it's spread. For example, if cancer spreads to the blood vessels within the kidney, your surgical oncologist may recommend removing the entire kidney.

Surgery is more common in earlier stages of kidney cancer when the removal of the tumor can result in remission. However, surgery may also be helpful in later stages. 

Targeted therapy

Targeted therapies use medication to target the proteins cancer uses to grow and spread. By inhibiting these proteins, it's possible to slow the spread of cancer cells and limit how much damage cancer can do to healthy tissue. Different cancers require different targeted therapy approaches, which may not be suitable for all cancer types. 

Immunotherapy

Immunotherapy utilizes your body's natural defenses, your immune system, to help kill cancer cells. The treatment teaches your body to identify cancer cells better and then attack and destroy them. By boosting your natural immune system, these therapies can help prevent the spread of cancer through the body, much like the immune system works to stop a virus. 

Radiation

Radiation uses targeted, high doses of radiation to damage cancer cells. After successful radiation treatment, damaged cancer cells may be unable to multiply. The radiation may also damage the DNA of the cells.

The damage can eventually cause the cells to die, after which the body will discard them. Radiation is usually reserved for later stages of kidney cancer, such as after it spreads to other areas of the body.

What is the survival rate once kidney cancer spreads?

If a doctor can diagnose kidney cancer in the earliest stages, patients have an excellent survival rate. However, once cancer spreads, survival rates begin to decline⁶:

• When cancer is isolated to the kidneys, the 5-year relative survival rate is 93%.

• When cancer starts to spread from the kidneys to nearby tissues such as the lymph nodes, the 5-year relative survival rate is 71%.

• When cancer spreads to other areas of the body, such as the lungs, bones, or brain, the 5-year relative survival rate is 14%.

On average, the survival rate for someone with kidney cancer is 76%. That means they have a 76% chance of living for at least five years compared to the general population. It's vastly improved since 1977 when the 5-year relative survival rate for kidney cancer was just 46.8%⁷.

The survival rate may continue to increase as researchers work on and introduce new treatment methods.

The lowdown

Kidney cancer is among the most common cancers in men and women in the United States. There are many different types of kidney cancer, but the most common type is renal cell carcinoma (RCC), which accounts for around 90% of all kidney cancer cases.

As the cancer cells in the kidneys multiply, they can spread beyond the kidneys into the surrounding blood vessels and lymph nodes. From there, cancer may spread to the lungs, brain, bones, pancreas, or liver. How quickly it spreads will depend on the type of cancer you have and your overall health.

Treatment options for kidney cancer may include surgery, immunotherapy, and radiation. The overall survival rate for kidney cancer is 76%, though there is a better chance of survival if the cancer is caught before it can spread beyond the kidneys. Once it spreads to other areas of the body, the survival rate drops to 14%.