TNM Definitions

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.[1-4] Proper staging should include computed tomography (CT) of the abdomen. Magnetic resonance imaging (MRI) may add specificity to CT evaluation of an adrenal mass.[5] In-phase and out-of-phase T1-weighted imaging may be the most effective noninvasive method to differentiate benign from malignant adrenal masses. MRI can also often clearly demonstrate any 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.[6] Vena caval contrast studies and angiography may provide additional staging information and allow for a more complete preoperative assessment. A review of published data from 608 patients revealed the following stage distribution at diagnosis: 3% stage I, 29% stage II, 20% stage III, and 49% stage IV.[7]

Stages are defined by TNM classification.[8]

Tumor (T)

• T1: Tumor 5 cm or less in size; invasion absent
• T2: Tumor greater than 5 cm in size; invasion absent
• T3: Tumor outside adrenal in fat
• T4: Tumor invading adjacent organs

Lymph nodes (N)

• N0: No positive lymph nodes
• N1: Positive lymph nodes

Metastases (M)

• M0: No distant metastases
• M1: Distant metastases

Stage I

• T1, N0, M0

Stage II

• T2, N0, M0

Stage III

• T1, N1, M0
• T2, N1, M0
• T3, N0, M0

Stage IV

• T3, N1, M0
• T4, N1, M0
• Any T, any N, M1

References

1. Cerfolio RJ, Vaughan ED Jr, Brennan TG Jr, et al.: Accuracy of computed tomography in predicting adrenal tumor size. Surg Gynecol Obstet 176 (4): 307-9, 1993.  [PUBMED Abstract]
   
   
2. Brennan MF: Adrenocortical carcinoma. CA Cancer J Clin 37 (6): 348-65, 1987 Nov-Dec.  [PUBMED Abstract]
   
   
3. Cohn K, Gottesman L, Brennan M: Adrenocortical carcinoma. Surgery 100 (6): 1170-7, 1986.  [PUBMED Abstract]
   
   
4. Nader S, Hickey RC, Sellin RV, et al.: Adrenal cortical carcinoma. A study of 77 cases. Cancer 52 (4): 707-11, 1983.  [PUBMED Abstract]
   
   
5. Doppman JL, Reinig JW, Dwyer AJ, et al.: Differentiation of adrenal masses by magnetic resonance imaging. Surgery 102 (6): 1018-26, 1987.  [PUBMED Abstract]
   
   
6. 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]
   
   
7. Wooten MD, King DK: Adrenal cortical carcinoma. Epidemiology and treatment with mitotane and a review of the literature. Cancer 72 (11): 3145-55, 1993.  [PUBMED Abstract]
   
   
8. Norton JA: Adrenal tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 7th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2005, pp 1528-39. 
   
   

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