The staging system is based on the combination of tumour size and extent of spread from the kidneys. The cancer spreads locally into the flank and then metastasises further afield, especially to the bones, lungs and also the brain and liver. 25% of patients present with metastatic disease. Symptoms of these metastatic sites of spread depend on the exact localisation of the spread, e.g. bone pain in the spine, pressure symptoms from brain metastases, coughing up blood from lung metastatic spread.
The staging therefore includes chest x-ray or CT scanning of the lungs as well as scanning of the abdomen. A whole body bone scan is also a part of the routine work-up. After CT scanning of the body and bone scan, the clinician should know whether the cancer has spread from the kidney.