1.5 Anatomical Staging of RCC
Staging cancer is a method of assessing how widespread the cancer is.
The staging is used to assess:
- Prognostic stage group (disease stage I-IV)
- Which treatment the patient can be offered
- Research
- Cancer monitoring
- Follow-up programme
Staging will be determined on the basis of a CT scan of the chest and abdomen before any surgery, as well as after surgery, where the pathologist assesses the size of the tumour and whether it has spread to adjacent organs and/or lymph nodes.
TNM classification
The TNM classification is an internationally used system for anatomical staging of solid tumours developed by the Union for International Cancer Control (UICC) and the American Joint Commision of Cancer (AJCC). TNM is an abbreviation of the English words Tumour, Node and Metastasis.1
- It is recommended to use UICCās 8th version of Tumour, Node, Metastasis (TNM) classification for staging kidney cancer
- TNM classification is used to define the anatomical spread of kidney cancer and categorise the patientās prognostic stage (stages I-IV)
- Generally speaking, the higher the stage, the poorer the prognosis2,3
TNM is defined based on tumour size and whether it grows into surrounding tissue (T), regional lymph node status (N), and presence or absence of distant metastases (M).4
RCC UICC TNM CLASSIFICATION
| T=TUMOUR | INVOLVEMENT | EXTENT OF DISEASE |
|---|---|---|
| T0 | No primary tumour | |
| T1 | ā¤ 7 cm | Limited to the kidney |
| T1a | ā¤ 4 cm | |
| T1b | > 4 cm til ā¤ 7 cm | |
| T2 | > 7 cm | Limited to the kidney |
| T2a | > 7 cm til ā¤ 10 cm | |
| T2b | > 10 cm | |
| T3 | Into the major veins or perinephric tissues | Not beyond renal fascia (Gerota’s fascia) |
| T3a | Into the renal vein or perinephric fat including fat in the renal sinus | Not beyond renal fascia (Gerota’s fascia) |
| T3b | Into the vena cava | Below the diaphragm |
| T3c | Into the vena cava | Above the diaphragm |
| T4 | Invasion beyond the renal fascia (Gerotaās fascia) | Including invasion into the ipsilateral adrenal gland |
RCC UICC TNM CLASSIFICATION
| Regional lymph nodes | |
|---|---|
| NX | Regional lymph nodes not assessed |
| N0 | No lymph node involvement |
| N1 | Regional lymph node involvement |
| Distant metastases | |
|---|---|
| M0 | No distant metastases |
| M1 | Distant metastases |
Stage of disease
Once T, N and M have been determined on the basis of CT scanning and/or after surgery, a stage grouping can subsequently be established where the above information is combined into 4 groups to determine the overall stage of the disease. The 4 groups are listed with Roman numerals from stage I (the earliest stage) to stage IV (the most prevalent stage). Generally, the higher the stage, the poorer the prognosis.4
| Distant metastases | |||
|---|---|---|---|
| Stage I | T1 | N0 | M0 |
| Stage II | T2 | N0 | M0 |
| Stage III | T3 | N0 | M0 |
| T1-T3 | N1 | M0 | |
| Stage IV | T4 | N0-N1 | M0 |
| T1-T4 | N0-N1 | M1 | |
References
- Kidney cancer (adult) ā renal cell carcinoma. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/003107-pdf.pdf. Accessed 14 June 2016.
- Delacroix Jr SE, Wood CG, Jonasch E. Renal neoplasia. I: Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu ASL, Brenner BM, eds. Brenner & Recterās The Kidney. 9th ed. Philadelphia, PA: Elsevier Saunders; 2012:1508ā1535.
- Deng FM, Melamed J. Histologic variants of renal cell carcinoma: does tumour type influence outcome? Urol Clin North Am. 2012;39(2):119-132, v.
- Kidney cancer stages. Cancer.Net.Ā http://www.cancer.net/cancer-types/kidney-cancer/stages. Accessed 20 June 2016.
