Understanding Your Stage 4 RCC Diagnosis: Insights on What to Expect

Receiving a diagnosis of stage 4 renal cell carcinoma (RCC) is a life-altering moment, but it is important to know that the treatment landscape has transformed significantly in the last few years. Stage 4 is considered "metastatic," meaning the cancer has spread beyond the kidney and nearby lymph nodes to distant parts of the body.

The goal of modern medicine in stage 4 is often to manage the cancer as a chronic condition, focusing on extending life while maintaining the best possible quality of life.

However, “Even though more than a quarter of patients think that no metastatic patients can be cured, over 50% believe that some of these patients can be cured,” Dena Battle, the co-founder and President of KCCure noted in a previous CURE article, highlighting the gap between perception and medical outcomes.

Overview of Stage 4 RCC

In stage 4, the primary tumor in the kidney has spread (metastasized). Common sites for RCC metastasis include:

• The Lungs: The most frequent site of spread.
• The Bones: Which may cause localized pain.
• The Liver or Brain: Less common, but monitored closely.
• The Adrenal Glands: Located just above the kidneys.

Understanding your IMDC Risk Category is crucial. Oncologists use a set of clinical criteria (such as your activity level and specific blood test results) to categorize the cancer as "Favorable," "Intermediate" or "Poor" risk. This classification helps determine which medications will work best for you.

Diagnosis and Monitoring of Stage 4 RCC

Diagnosis at this stage involves identifying exactly where the cancer is located to create a roadmap for treatment.

• Biopsy: A small tissue sample is usually taken from either the kidney or a metastatic site to confirm the specific cell type (e.g., clear cell RCC, which is the most common).
• Full-Body Imaging: You will likely receive CT scans of the chest, abdomen and pelvis. An MRI of the brain or a bone scan may be ordered if you are experiencing specific symptoms.
• Lab Work: Doctors look for specific "markers" in your blood, including calcium levels, hemoglobin (red blood cells) and LDH (an enzyme that can indicate tissue damage).

Treatment Options for Stage 4 Kidney Cancer

In stage 4, "systemic" therapy (medicine that travels through the entire bloodstream) is the backbone of treatment, rather than surgery alone.

First-Line Systemic Therapies

Most patients now start with a "combination" therapy, which is more effective than using one drug alone:

• Immunotherapy Duos: Using two drugs (like Opdivo (nivolumab)plusYervoy (ipilimumab)) to "unmask" the cancer so your own immune system can attack it.
• IO + TKI Combinations: Combining an Immunotherapy (IO) drug with a targeted therapy such as Keytruda (pembrolizumab)plus Inlyta (axitinib). The TKI works by cutting off the blood supply to the tumors.

The Role of Surgery and Radiation

• Cytoreductive Nephrectomy: In some cases, the surgeon may still remove the primary kidney tumor to reduce the overall "burden" of cancer in the body.
• Palliative Radiation: Used specifically to target painful bone metastases or brain lesions to improve comfort.

Side Effects of Stage 4 Kidney Cancer Treatment

Because stage 4 treatments circulate through the whole body, side effects can be diverse. Managing them early is key to staying on treatment.

• Immunotherapy can cause inflammation of the colon, leading to diarrhea; the skin, resulting in rashes; or the lungs, causing cough.
• Steroids are often used to calm the immune system if it becomes overactive.
• Targeted therapy, such as tyrosine kinase inhibitors (TKIs), may cause high blood pressure, fatigue, diarrhea and hand-foot syndrome, which presents as blisters or soreness on the hands and feet; management typically includes dose adjustments and topical creams for skin issues.
• More generally, fatigue and loss of appetite can occur with various treatments and are often addressed through nutritional support and light exercise.

What to Take Away

A stage 4 diagnosis is a marathon, not a sprint. The "standard of care" is shifting rapidly, and many patients are now living years with metastatic disease thanks to the arrival of dual-agent therapies. Your relationship with your oncology team is your most valuable asset.

“Let’s say cure,” Battle urged in the article, encouraging clear and compassionate communication that aligns patient experience with medical reality.

Questions to Drive the Conversation with Your Oncologist:

• "What is my IMDC risk score, and how does that affect my first treatment choice?"
• "Are we starting with a combination of two immunotherapies, or an immunotherapy plus a targeted drug?"
• "What is the goal of our first line of treatment—shrinkage, or stabilization?"
• "Who should I call immediately if I develop a new cough or severe diarrhea while on immunotherapy?"
• "Are there any clinical trials available that might be appropriate for my specific cell type?"

Reference

1. “Cured or Consumed? How Kidney Cancer Patients Experience Survival,” by Ryan Scott. CURE; Dec. 2, 2025. https://www.curetoday.com/view/cured-or-consumed-how-kidney-cancer-patients-experience-survival

Editor's note: This article is for informational purposes only and is not a substitute for professional medical advice, as your own experience will be unique. Use this article to guide discussions with your oncologist. Content was generated with AI, reviewed by a human editor, but not independently verified by a medical professional.

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