TNM Definitions
AJCC Stage Groupings

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 renal masses.[4]

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[5]

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• T1: Tumor 7 cm or less in greatest dimension and limited to the kidney
  • T1a: Tumor 4 cm or less in greatest dimension and limited to the kidney
  • T1b: Tumor larger than 4 cm but 7 cm or less in greatest dimension and limited to the kidney
• T2: Tumor larger than 7 cm in greatest dimension and limited to the kidney
• T3: Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond Gerota fascia
  • T3a: Tumor directly invades adrenal gland or perirenal and/or renal sinus fat but not beyond Gerota fascia
  • T3b: Tumor grossly extends into the renal vein or its segmental (i.e., muscle-containing) branches, or it extends into the vena cava below the diaphragm
  • T3c: Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava
• T4: Tumor invades beyond Gerota fascia

Regional lymph nodes (N)*

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in a single regional lymph node
• N2: Metastasis in more than one regional lymph node

* [Note: Laterality does not affect the N classification.]

 [Note: If a lymph node dissection is performed, then pathologic evaluation would ordinarily include at least eight nodes.]

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

Stage I

• T1, N0, M0

Stage II

• T2, N0, M0

Stage III

• T1, N1, M0
• T2, N1, M0
• T3, N0, M0
• T3, N1, M0
• T3a, N0, M0
• T3a, N1, M0
• T3b, N0, M0
• T3b, N1, M0
• T3c, N0, M0
• T3c, N1, M0

Stage IV

• T4, N0, M0
• T4, N1, M0
• Any T, N2, M0
• Any T, any N, M1

References

1. 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]
   
   
2. Golimbu M, Joshi P, Sperber A, et al.: Renal cell carcinoma: survival and prognostic factors. Urology 27 (4): 291-301, 1986.  [PUBMED Abstract]
   
   
3. Robson CJ, Churchill BM, Anderson W: The results of radical nephrectomy for renal cell carcinoma. J Urol 101 (3): 297-301, 1969.  [PUBMED Abstract]
   
   
4. Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988.  [PUBMED Abstract]
   
   
5. Kidney. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 323-5. 
   
   

Back to Top

< Previous Section  |  Next Section >