# Symptoms and stages of kidney cancer
Kidney cancer progresses in different stages, each with its own characteristics and manifestations. The course is highly individual: some tumors grow slowly, others more quickly. This description provides insight into what people may experience at different stages.
Stage I: Early, localized tumor (still confined to the kidney)
At this stage, the tumor is still only in the kidney and is usually small (less than 7 centimeters). **Many patients have no symptoms at all in this phase.** The tumor is often discovered by chance on a CT scan or ultrasound that was performed for a completely different reason.
When symptoms do occur, they may include:
- **Blood in the urine** (sometimes visible, sometimes only under the microscope)
- **Flank or back pain** on the side of the affected kidney
- **Vague abdominal complaints** or discomfort on the side
For daily life, this stage usually means little. Many patients feel well and notice nothing of the tumor.
**Population-level figures:** Stage I tumors have a favorable outlook. Large series (2015–2020) show that approximately 80–95% of patients with stage I are still alive at least 5 years later — but this says nothing about one individual and depends strongly on personal factors.
Stage II: Larger tumor, still in the kidney
The tumor is larger (more than 7 centimeters) but still remains within the kidney capsule. Here too, many patients **have no noticeable symptoms**.
Symptoms that may occur:
- **Blood in the urine**
- **Back or side pain** (may be stronger than in stage I)
- **Fatigue** or general feeling of malaise
- **Low-grade fever** or fever (in some cases)
In daily life, patients can usually still feel normal, even though the tumor is growing. Some notice somewhat more fatigue or discomfort in the flank.
**Population-level figures:** Stage II also has a reasonable prognosis. Five-year survival is around 65–80% in large cohorts (data 2015–2020), but this average masks large individual differences.
Stage III: Tumor breaks out of the kidney, reaches renal vessels or lymph nodes
In stage III, the tumor grows through the kidney capsule. Sometimes a so-called tumor thrombus (a bulging of tumor cells) grows into the renal arteries or inferior vena cava. Or there are metastases in nearby lymph nodes.
Symptoms in this phase:
- **Blood in the urine** (may be more complete and darker)
- **Severe back or side pain**
- **Fatigue and weakness**, sometimes more pronounced than before
- **Weight loss** (unintentional)
- **Fever** (without clear infection)
- **Night sweats**
- **Abdominal complaints** or feeling of fullness due to swelling in the area
- **High blood pressure** (due to hormones the tumor may secrete)
For daily life, the effects become clearer. People may feel more tired, eat less, experience pain that sometimes requires medication, and feel generally less well.
**Population-level figures:** Stage III patients have a more mixed picture. Median overall survival (time until death regardless of cause) was estimated in large studies (2010–2020) at 4–8 years, but with large variation. Many factors (such as tumor type, age, general health) determine the personal course.
Stage IV: Metastatic kidney cancer (distant metastases)
This is the most advanced form. The tumor has spread to distant organs: usually lungs, bones, liver, or brain. The patient has **metastatic disease** or **metastatic kidney cancer**.
Symptoms depend on where the metastases are located:
**General symptoms: **
- **Severe fatigue** and exhaustion
- **Weight loss** (often noticeable)
- **Fever** (variable)
- **Night sweats**
- **Decreased appetite**
- **General malaise**
- **Blood in the urine** (may persist)
- **Back or abdominal pain**
**Depending on metastasis location:**
- **Lung metastases:** shortness of breath, cough, sometimes hemoptysis
- **Bone metastases:** pain in legs, pelvis or spine; risk of bone fractures
- **Brain metastases:** headache, dizziness, speech disorders, confusion
- **Liver metastases:** jaundice, abdominal pain, bloating
For daily life, stage IV has major consequences. Many patients feel clearly ill, can do normal activities less well, have pain that requires treatment, may have difficulty eating and feel fear or worry about what is to come.
**Population-level figures:** Metastatic renal cancer has a more serious outlook. Median overall survival is estimated in recent series (2015–2023) at 12–36 months, depending on number and location of metastases and response to treatment. But again: this is an average across large groups. Some patients live longer, others have a shorter course — no one can predict this for one person based on averages. Modern treatments (immunotherapy, targeted therapies) have improved the outlook in recent years.
When to contact your doctor
Contact your doctor or hospital if you:
- **See significantly more blood in your urine**
- **Have severe pain** that does not go away or gets worse
- **Develop high fever** that does not resolve
- **Become suddenly very tired** or cannot get out of bed
- **Have difficulty eating and drinking** and lose weight quickly
- **Experience shortness of breath or chest pain**
- **Develop confusion, headache or loss of consciousness**
- **Get other new, concerning symptoms** that are unusual in your situation
Many of these symptoms can have other causes, but it is important to always report them to your team so they can investigate what is going on.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._