Kidney Cancer: TNM Staging

T staging

AJCC 8th edition (2017)[1]

• TX Primary tumor cannot be assessed
• T0 No evidence of primary tumor
• T1
  • T1a: Tumor ≤ 4.0 cm and confined to the kidney
  • T1b: Tumor > 4.0 cm and ≤ 7.0 cm and confined to the kidney
• T2
  • T2a: Tumor > 7.0 cm and ≤ 10.0 cm and confined to the kidney
  • T2b: Tumor > 10.0 cm and confined to the kidney
• T3
  • T3a: Tumor
    1. Grossly extends into the renal vein or its segmental branches OR
    2. Invades pelvicalyceal system OR
    3. Invades perirenal and/or renal sinus fat but not beyond Gerota fascia
       • Invasion of the perisinus fat medially has been shown to have worse prognosis that perirenal fat laterally.
         • Medial invasion places the tumor in proximity to the venous system and likely increases the risk of metastatic dissemination
  • T3b: Tumor grossly extends into the vena cava below the diaphragm
  • T3c: Tumor
    1. Grossly extends into the vena cava above the diaphragm OR
    2. Invades the wall of the vena cava
• T4: Tumor invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)
  • Ipsilateral adrenal involvement is even worse, and these are now classified as pT4 if due to direct local extension, or pM1 otherwise, consistent with a hematogenous route of dissemination.

N staging

• NX Regional lymph nodes cannot be assessed
• N0 No regional lymph nodes metastasis
• N1 Metastasis in regional lymph node(s) (5 yr survival 0-20%)

M staging

• MX Distant metastasis cannot be assessed
• M0 No distant metastasis
• M1 Distant metastasis present (5 yr survival 0-10%)

Questions

1. What is the T staging for RCC?

Answers

1. What is the T staging for RCC?
   • T1a: tumor ≤ 4.0 cm and confined to the kidney
   • T1b: tumor > 4.0 cm and ≤ 7.0 cm and confined to the kidney
   • T2a: tumor > 7.0 cm and ≤ 10.0 cm and confined to the kidney
   • T2b: tumour > 10cm and confined to the kidney
   • T3a: tumour invades renal vein or its segmental branch or pelvicalyceal system or perirenal/perihilar fat
   • T3b: tumour invades IVC below diaphragm
   • T3c: tumour invades IVC above diaphragm or wall of IVC
   • T4: tumour invades outside of Gerota’s fascia including contiguous extension into the ipsilateral adrenal gland

References

• Amin MB, Edge S, Greene F, Byrd DR, Brookland RK, Washington MK, Gershenwald JE, Compton CC, Hess KR, et al. (Eds.). AJCC Cancer Staging Manual (8th edition). Springer International Publishing: American Joint Commission on Cancer; 2017
• AJCC Cancer Staging Handbook, 7th edition, 2010
• AJCC Cancer Staging Handbook, 6th edition, 2002