Stage 2 kidney cancer — what it means and how it is treated

Stage 2 means the tumour in your kidney is larger than 7 cm across, but it is still contained inside the kidney. The staging scans found no cancer in the nearby lymph nodes and no sign of spread to distant organs such as the lungs, bones or liver. In the TNM system this is written as T2, N0, M0. It is the size, and only the size, that separates stage 2 from stage 1, where the tumour is 7 cm or smaller. Stage 2 is still classed as localised kidney cancer, which is why surgery to remove it is normally the main treatment rather than drug therapy.

Both are stage 2, and the difference between them is size alone. T2a means the tumour is more than 7 cm across but not more than 10 cm. T2b means it is more than 10 cm. In both, the cancer is still inside the kidney, the lymph nodes are clear and there is no distant spread. Your report may show the T category rather than the words stage 2a or stage 2b, and the two describe the same thing. A larger tumour can make the surgery more demanding and makes removing the whole kidney more likely, but it does not by itself move the cancer into a higher stage.

Surgery is the mainstay. Because a stage 2 tumour is over 7 cm, removing the whole kidney, a radical nephrectomy, is usually recommended, though a kidney-sparing operation is considered in selected situations such as a single working kidney or reduced kidney function. At CION this surgery is coordinated for you with specialist urology and uro-oncology partners, where it may also be billed. Conventional chemotherapy has no routine role in kidney cancer. After surgery the pathology report decides what follows: adjuvant immunotherapy is considered for selected people at higher risk of the cancer returning, along NCCN lines, and everyone else moves to a scheduled follow-up plan.

Stage 2 kidney cancer is still confined to the kidney, so it is treated with the intention of removing it completely, and many people need no drug treatment at all afterwards. Nobody can promise an outcome in advance, and no honest oncologist will. What can be said is that a cancer which has not left the kidney sits in the group treated for cure rather than for control. The pathology from the removed kidney, including the grade and the subtype, refines that picture considerably. Ask your oncologist to explain your own findings rather than reading survival figures written for everyone with the same stage number.

Chemotherapy is not used, because kidney cancer does not respond to conventional chemotherapy the way many other cancers do. Immunotherapy is a different question. For selected people whose pathology suggests a higher risk of the cancer coming back, a course of adjuvant immunotherapy using a PD-1 inhibitor is discussed after surgery along NCCN lines. It is not given to everyone with stage 2, and the decision rests on the grade, the subtype and features such as sarcomatoid change rather than on the stage alone. If it applies to you, it is delivered in-house by our medical oncology team.

Stage 2 means the tumour is still inside the kidney, however large it is. Stage 3 means the cancer has gone somewhere it should not have: into the fat surrounding the kidney, into a major vein such as the renal vein or the vena cava, or into nearby lymph nodes. Size is not what makes the difference. A tumour of 12 cm that has stayed inside the kidney is stage 2, while a much smaller one that has reached a lymph node is stage 3. This is why the report is read as a whole, and why the final stage is sometimes only settled after the kidney has been removed and examined.