Stage Information for Renal Cell Cancer
The staging system for renal cell cancer is based on the degree of tumor spread
beyond the kidney.[1-3] Involvement of blood vessels may not be a poor
prognostic sign if the tumor is otherwise confined to the substance of the
kidney. Abnormal liver function test results may be caused by a paraneoplastic
syndrome that is reversible with tumor removal, and these types of results do not necessarily represent
metastatic disease. Except when computed tomography (CT) examination is
equivocal or when iodinated contrast material is contraindicated, CT scanning
is as good as or better than magnetic resonance imaging for detecting
Definitions of TNM
The American Joint Committee on Cancer has designated staging by TNM
classification to define renal cell cancer.
Table 1. Primary Tumor (T)a
||Primary tumor cannot be assessed.
||No evidence of primary tumor.
||Tumor ≤7 cm in greatest dimension, limited to the kidney.
||Tumor ≤4 cm in greatest dimension, limited to the kidney.
||Tumor >4 cm but not >7 cm in greatest dimension, limited to the kidney.
||Tumor >7 cm in greatest dimension, limited to the kidney.
||Tumor >7 cm but ≤10 cm in greatest dimension, limited to the kidney.
||Tumor >10 cm, limited to the kidney.
||Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota fascia.
||Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota fascia.
||Tumor grossly extends into the vena cava below the diaphragm.
||Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava.
||Tumor invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal gland).
Table 2. Regional Lymph Nodes (N)a
||Regional lymph nodes cannot be assessed.
||No regional lymph node metastasis.
||Metastases in regional lymph node(s).
Table 3. Distant Metastasis (M)a
||No distant metastasis.
Table 4. Anatomic Stage/Prognostic Groupsa
||T1 or T2
||N0 or N1
- Bassil B, Dosoretz DE, Prout GR Jr: Validation of the tumor, nodes and metastasis classification of renal cell carcinoma. J Urol 134 (3): 450-4, 1985. [PUBMED Abstract]
- Golimbu M, Joshi P, Sperber A, et al.: Renal cell carcinoma: survival and prognostic factors. Urology 27 (4): 291-301, 1986. [PUBMED Abstract]
- Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 101 (3): 297-301, 1969. [PUBMED Abstract]
- Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988. [PUBMED Abstract]
- Kidney. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 479-89.