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Adrenocortical Carcinoma Treatment (PDQ®)

Health Professional Version
Last Modified: 11/15/2012

Stage Information for Adrenocortical Carcinoma

Definitions of TNM

There are several staging systems in use. The American Joint Committee on Cancer (AJCC) staging system [1] is based on the following assessment:

The stage of adrenocortical carcinoma is determined by the size of the primary tumor, the degree of local invasion, and whether it has spread to regional lymph nodes or distant sites. Proper staging should include computed tomography (CT) of the abdomen and chest. Magnetic resonance imaging (MRI) may add specificity to CT evaluation of an adrenal mass.[2] In-phase and out-of-phase T1-weighted imaging may be the most effective noninvasive method to differentiate benign from malignant adrenal masses. MRI may suggest evidence of extracapsular tumor invasion, extension into the vena cava, or metastases. Patency of surrounding vessels can often be demonstrated with gadolinium-enhanced sequences or flip-angle techniques.[3]

In addition to the above-mentioned AJCC staging, the European Network for the Study of Adrenal Tumors (ENSAT) staging system is widely used internationally.[4] The ENSAT staging system is essentially the same as the AJCC system, but reserves stage IV only for tumors with distant metastasis. Other staging systems include the classical Macfarlane system, modified by Sullivan, and the Union Internationale Contre le Cancer staging system, published by the World Health Organization.[5]

Definitions of TNM

The AJCC has designated staging by TNM to define adrenocortical carcinoma.[1]

Table 1. Primary Tumor (T)a
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
T1Tumor ≤5 cm in greatest dimension, no extra-adrenal invasion.
T2Tumor >5 cm, no extra-adrenal invasion.
T3Tumor of any size with local invasion, but not invading adjacent organs.b
T4Tumor of any size with invasion of adjacent organs.b

aReprinted with permission from AJCC: Adrenal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 515-20.
bAdjacent organs include kidney, diaphragm, great vessels, pancreas, spleen, and liver.

Table 2. Regional Lymph Nodes (N)a
aReprinted with permission from AJCC: Adrenal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 515-20.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastases in regional lymph node(s).

Table 3. Distant Metastasis (M)a
aReprinted with permission from AJCC: Adrenal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 515-20.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groupsa
Stage T N M 
aReprinted with permission from AJCC: Adrenal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 515-20.
IT1N0M0
IIT2N0M0
IIIT1N1M0
T2N1M0
T3N0M0
IVT3N1M0
T4N0M0
T4N1M0
Any TAny NM1

References
  1. Adrenal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 516-7. 

  2. Doppman JL, Reinig JW, Dwyer AJ, et al.: Differentiation of adrenal masses by magnetic resonance imaging. Surgery 102 (6): 1018-26, 1987.  [PUBMED Abstract]

  3. Brown ED, Semelka RC: Magnetic resonance imaging of the adrenal gland and kidney. Top Magn Reson Imaging 7 (2): 90-101, 1995 Spring.  [PUBMED Abstract]

  4. Fassnacht M, Johanssen S, Quinkler M, et al.: Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma: proposal for a Revised TNM Classification. Cancer 115 (2): 243-50, 2009.  [PUBMED Abstract]

  5. Allolio B, Fassnacht M: Clinical review: Adrenocortical carcinoma: clinical update. J Clin Endocrinol Metab 91 (6): 2027-37, 2006.  [PUBMED Abstract]