Grading kidney cancer

Grading describes how the cancer cells look compared to normal, healthy cells. Knowing the grade gives your healthcare team an idea of how quickly the cancer may be growing and how likely it is to spread. This helps them plan your treatment. The grade can also help the healthcare team predict future outcomes (your prognosis) and how the cancer might respond to treatment.

To find out the grade of kidney cancer, a pathologist looks at a tissue sample from the tumour under a microscope. They look at how different the cells look from normal cells (called differentiation) and other features of the tumour such as the size and shape of the cells and how the cells are arranged. They can usually tell how fast a tumour is growing by looking at how many cells are dividing.

The pathologist gives kidney cancer a grade from 1 to 4 (often called Fuhrman grade). A lower number means the cancer is a lower grade.

Low-grade cancers have cancer cells that are well differentiated. The cells are abnormal but look a lot like normal cells and are arranged a lot like normal cells. Lower-grade cancers tend to grow slowly and are less likely to spread.

High-grade cancers have cancer cells that are poorly differentiated or undifferentiated. The cells don’t look like normal cells and are arranged very differently. Higher-grade cancers tend to grow more quickly and are more likely to spread than low-grade cancers.

Expert review and references

  • Kassouf W, Monteiro LL, Drachenberg DE, et al. . Canadian Urological Association guideline for followup of patients after treatment of non-metastatic renal cell carcinoma. Canadian Urological Association Journal. 2018: https://www.kidneycancercanada.ca/media/1173873/5462-22379-1-pb.pdf.
  • Lane BR, Canter DJ, Rin BL, et al . Cancer of the kidney. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2015: 63:865-884.
  • Shuch B, Finley DS, Pouliot F, et al . Molecular and clinical prognostic factors in renal cell carcinoma. Scardino PT, Lineham WM, Zelefsky MJ & Vogelzang NJ (eds.). Comprehensive Textbook of Genitourinary Oncology. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2011: 40: pp. 667-75.