Kidney cancer is among the most common cancers in adults, accounting for nearly 4% of all cancers. According to estimates from the American Cancer Society, about 82,000 cases will be diagnosed this year in the US, and nearly 15,000 people will die from the disease.

Over time, especially when kidney cancer remains undetected, or when early treatment is unsuccessful, this type of cancer tends to metastasize (spread) to other areas of the body. Kidney cancer can spread to surrounding tissues or lymph nodes, known as regional metastases or stage III kidney cancer, as well as distant parts of the body, called stage IV kidney cancer.

Compared to localized, early-stage kidney cancer, metastatic kidney cancer is more difficult to treat and is associated with lower survival rates.

In this guide, you'll learn where kidney cancer tends to spread, promising new treatment options, prognosis, and survival rates for metastatic kidney cancer patients, and more, with stories from real patients.

In the Inspire Kidney Cancer Community, members share their personal experiences of living with renal cancer and how to find support. This content should not be used as a substitute for professional medical advice, diagnosis, or treatment. As always, consult with your doctor before trying any new treatments or medications.

Where does kidney cancer spread? Kidney cancer metastasis sites

Kidney cancer can potentially spread anywhere in the body, but some metastasis sites are more common than others. The likely areas that may be affected also vary depending on whether a patient has clear cell renal cell carcinoma (ccRCC), transitional cell carcinoma (TCC), or the much rarer renal sarcoma.

Metastasis can occur prior to treatment when kidney cancer remains undiagnosed for prolonged periods of time, but it can also happen after early treatment, such as nephrectomy (kidney removal). Statistically speaking, tumors that are smaller than 3 centimeters (about 1.2 inches) are unlikely to spread.

If you receive treatment for renal cancer, your doctor will likely recommend regular follow-up scanning using imaging technologies like ultrasound, CT scans, or MRIs to monitor for metastasis and other potential issues.

Stage III kidney cancer, also called local metastatic kidney cancer, is a type of advanced kidney cancer. In stage III kidney cancer, the cancer cells have spread to nearby lymph nodes, blood vessels in or near the kidney, the structures in the kidney that collect urine, or the layer of fatty tissue around the kidney.

Stage IV kidney cancer is a more advanced classification than stage III. This stage occurs when distant metastases exist — i.e., when the cancer cells have spread beyond the fatty tissue surrounding the kidney to other parts of the body.

Metastatic clear cell renal cell carcinoma

According to a study of over 11,000 patients with metastatic clear cell renal cell carcinoma (mccRCC), the most common metastasis sites were as follows:

• lung (45%)

• bone (30%)

• lymph node (22%)

• liver (20%)

• adrenal gland (9%)

• brain (9%)

However, mccRCC can spread to virtually any area of the body, and it is relatively common for it to spread to multiple organs.

Clear cell carcinoma, also called clear cell adenocarcinoma, is a type of cancer that is clear when viewed under a microscope. It occurs most often in the kidneys (clear cell renal cell carcinoma) but can also affect the female reproductive tract (ovarian, cervical, or uterine clear cell carcinoma) or the gastrointestinal tract (clear cell colorectal carcinoma). Learn more. 

Metastatic transitional cell cancer

After clear cell renal cell cancer (ccRCC), transitional cell cancer (TCC) or urothelial cancer is the next most common type of kidney cancer. However, it only accounts for around 7% of kidney cancer cases, making it far less common than ccRCC. 

This type of cancer originates in the urothelial cells that line the renal pelvis, bladder, and ureters (long, thin tube that carries urine from the kidney to the bladder). TCC can affect any of these areas but more frequently affects the ureters or bladder than the kidneys themselves.

Common metastasis sites for TCC include the pelvic lymph nodes, lungs, liver, bones, adrenal gland, and brain. Metastases to the heart, kidney, spleen, pancreas, and reproductive system are unusual but have been documented.

The most common type of kidney cancer is clear cell renal cell carcinoma (ccRCC), while less common types include other non-clear-cell RCC subtypes, urothelial cell or transitional cell cancer, and renal sarcoma. Learn more. 

Metastatic renal sarcoma

Renal sarcoma, a type of cancer that originates in the connective tissue of the kidney, is one of the rarest types of kidney cancer. It affects fewer than 1% of adult kidney cancer patients.

According to a small study, the most common metastasis sites for renal sarcoma were the lungs, lymph nodes, and liver.

Metastatic kidney cancer treatments

The most promising treatments for metastatic kidney cancer are systemic therapies, particularly immunotherapy and targeted therapies. These treatments are often given in combination. Goals include slowing or halting tumor growth and metastasis and reducing symptoms caused by cancer. Occasionally, in some cases, tumors disappear altogether.

For nonmetastatic or localized kidney cancer, doctors often advise surgical treatment, including partial or full nephrectomy (kidney removal) or nephroureterectomy (removal of the affected kidney and ureter). 

In the past, most doctors recommended against surgery for metastatic kidney cancer due to the fact that it has already spread outside the kidney, but new research indicates that for some patients, a combination of surgery and systemic treatment can be successful.

Chemotherapy may be used occasionally. However, some types of advanced or metastatic kidney cancers are chemotherapy-resistant.

Finally, radiation treatment is sometimes provided to ease symptoms, though it is generally not effective at slowing or preventing kidney cancer growth.

Following treatment for metastatic kidney cancer, your medical team is likely to advise regular follow-up scans and tests to assess whether the treatment strategy was successful and to help determine the next steps.

Immunotherapy uses your immune system to fight cancer. Immunotherapy drugs take advantage of naturally occurring molecules found in cancer cells, called tumor antigens, to target cancer cells and attempt to kill or limit them with your body's immune system. Learn more about immunotherapy. 

Metastatic kidney cancer prognosis and survival

Patients whose kidney cancer is detected at an earlier stage tend to have better survival rates. Unfortunately, in some cases, kidney cancer is asymptomatic (without symptoms) and therefore is not detected until it spreads.

A study of kidney cancer patients determined the following five-year survival rates: 

• 88% for stage I cancer 

• 63% for stage II cancer 

• 65% for stage III (locally advanced) cancer 

• 15% for stage IV (metastatic) cancer 

Kidney cancer stages are categorized according to the size of the primary tumor that exists in the kidney. Stage IV kidney cancer is metastatic, meaning it has spread to other areas.

According to a 2020 study of over 1,600 patients with renal cell carcinoma (RCC), the most common type of kidney cancer, survival following nephrectomy (kidney removal) surgery depended on the stage of the cancer. Five-year survival rates after kidney removal were as follows:

• 97.4% in stage I RCC patients

• 89.9% in stage II RCC patients

• 77.9% in stage III RCC patients

• 26.7% in stage IV RCC patients

A small study of renal sarcoma, a rare form of kidney cancer, found an average survival time of eight months after metastasis. However, this study was conducted in 2011, so it is possible that survival times have increased due to advances in treatment.

Living with metastatic kidney cancer: Patient stories

In the Inspire Community, survivors share tips on how to discuss your kidney cancer findings with your doctor:

"When they removed that tumor, was it a regular shape, or 'infiltrating' (reaching out finger-like projections)? Was it 'well circumscribed' (had a nice cover around it)? Was it entirely inside the kidney capsule, or reaching beyond it? What was its rate of growth (they usually talk about the 'doubling rate' or the time it takes to double in volume).

Those tend to be the characteristics that are more telling than just size, though size is the handiest measure. If you are worried, I would have a frank discussion with your doctor and ask him what he feels are the odds that there are metastases out there. They can't give you a flat yes or no answer, but they might be willing to say 'I'm 90% sure' or 'I'm only about 60% sure' that there will not be a future metastasis out there.

You are right to be watchful, just don't get yourself all anxious about it. Manage your stress. Try to keep it down to a hum." Go to post

Kidney cancer can metastasize (spread) to the bones or other areas of the body, especially when it remains undetected:

"I was recently diagnosed with stage IV renal cancer. It all started from a bump on my head. Xrays, CT scans, MRIs, blood tests, bone scan and a biopsy of the lesion on my skull showed renal cancer. Then more scans showed my left kidney and the mass. Bone scan shows 3 small spots, each hip and rib. Before finding this I was pretty healthy. No family history, non smoker, great blood pressure! This has my mind boggled. One split second my life changed." Go to post

"My husband has Stage 4 RCC. His tumor in the kidney was 5 cm but it had spread to his spine where it had completely dissolved his T5 vertebrae and rib, causing spinal cord compression, thus the cancer discovery. It was found in other bones, too. He has had surgery, is walking again, and he has been on a new treatment now for 2 years!! The kidney tumor had shrunk down to 1.9 centimeters." Go to post 

Pain management can be challenging with kidney cancer, or any type of cancer:

"I have been recently diagnosed with clear cell renal carcinoma that has spread to my right lung and right breast....I have not started treatment yet. But I am in a great deal of pain in my upper back which they say is due to the mass in the lung. I am doing acupuncture and pain meds. But neither work entirely." Go to post 

Immunotherapy is a relatively new, promising treatment for clear cell renal cell carcinoma:

"I finally had a CT scan to follow up my diagnosis of kidney cancer stage 3, clear cell carcinoma, from eight months ago. I had a post-radical nephrectomy. Looks like the Keytruda immunotherapy is working, no NEW cancer growth and my lung nodules are unchanged. The nasty side effects are worth it then!" Go to post 

While treatments can be challenging, they can also be very effective for keeping kidney cancer in remission:

"There are definitely side effects, but my experience of being sicker than a dog, worst flu ever, mostly out of it during treatment, lots of nausea and super sleepiness, episodes of low blood pressure, etc is quite nicely balanced by the fact that I am alive and well, have not taken any kidney cancer meds for nearly 12 years....There was no pain, no Exorcism-style reactions! There are definitely risks, and it must be given in a good and experienced center. Just as you would not want to be the first person getting a kidney removed by a new surgeon in a new setting, you want to go where they have a history of doing the procedures you need." Go to post 

"I also was diagnosed with stage IV renal clear cell cancer about a year and a half ago. My kidney was removed the following month. Three months later a scan showed I had metastases in my lungs. I tried high-dose Interleukin II at the beginning of the following year, but my tumors continued to grow. I was started on Sutent two months later and have been taking it ever since....My tumors are now considered to be "stable" (neither growing nor reducing in size)....Get a doctor who "specializes" with Renal Cell Carcinoma and who is up to date on the latest medications." Go to post

"My husband has had stage 4 clear cell RCC for three years. He is currently on Keytruda every 3 weeks and Inlyta twice a day since last year. Comparing his PET/CT scan results from this time period shows vast improvement. Finally something that is working." Go to post 

Want to connect with other people living with kidney cancer and their caregivers today? Visit the Inspire Kidney Cancer Community.

Sources

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Disclaimer 

Member comments have been lightly edited for length and clarity. This content is for general informational purposes only and does not necessarily reflect the views and opinions of any organization or individual. The content should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult your healthcare provider about any questions you may have regarding a medical condition.