Difference between revisions of "Kidney cancer staging"
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[[Image:Diagram showing stage 1 kidney cancer CRUK 192.svg|thumb|Schematic showing a T1 kidney cancer. (WC/CRUK)]] | [[Image:Diagram showing stage 1 kidney cancer CRUK 192.svg|thumb|Schematic showing a T1 kidney cancer. (WC/CRUK)]] | ||
The article deals with '''kidney cancer staging'''. | [[Image:Anterior and posterior renal fascia.jpg|thumb|Schematic showing the ''anterior renal fascia'' and ''posterior renal fascia'' (collectively known as ''Gerota's fascia''). (WC/Mitreski & Sutherland)]] | ||
The article deals with '''kidney cancer staging''' for [[renal cell carcinoma]]. A general discussion of staging is found in ''[[cancer staging]]''. | |||
==General== | ==General== | ||
*TNM staging used. | *TNM staging used. | ||
*[[Urothelial carcinoma]] of the kidney has a different staging system. | |||
==TNM staging system== | ==TNM staging system== | ||
Line 12: | Line 14: | ||
! Comments | ! Comments | ||
|- | |- | ||
| T1a | | T1a | ||
| <=4 cm, confined to kidney | | <=4 cm, confined to kidney | ||
| common | | common | ||
Line 18: | Line 20: | ||
| T1b | | T1b | ||
| >4 cm and <=7 cm, confined to kidney | | >4 cm and <=7 cm, confined to kidney | ||
| | | uncommon | ||
|- | |- | ||
| T2 | | T2 | ||
| >7 cm, confined to kidney | | >7 cm, confined to kidney | ||
| rare - most large tumours are T3a | | rare - most large tumours are T3a | ||
|- | |- | ||
| T3a | | T3a | ||
| any size with sinus invasion (see below) or perinephric invasion | | any size with sinus invasion (see below) or perinephric invasion | ||
| very common | | very common | ||
Line 30: | Line 32: | ||
| T3b | | T3b | ||
| tumour in a caval thrombus below the diaphragm without invasion or adherence to the wall of the cava | | tumour in a caval thrombus below the diaphragm without invasion or adherence to the wall of the cava | ||
| uncommon | | very uncommon | ||
|- | |- | ||
| T3c | | T3c | ||
| tumour in a caval thrombus above the diaphgram or with invasion or adherence to the wall of the cava | | tumour in a caval thrombus above the diaphgram or with invasion or adherence to the wall of the cava | ||
| uncommon | | very uncommon | ||
|- | |- | ||
| T4 | | T4 | ||
Line 41: | Line 43: | ||
|} | |} | ||
Notes: | |||
*T2 is formally split into T2a (>7 cm and <=10 cm) and T2b (>10 cm); however, this subdivision does not appear to have prognostic valve. | *Most cases are pT1a or pT3a. | ||
**pT2 is very rare and pT1b is uncommon for [[CCRCC]] - in a series of 120 cases:<ref name=pmid16145369>{{Cite journal | last1 = Bonsib | first1 = SM. | title = T2 clear cell renal cell carcinoma is a rare entity: a study of 120 clear cell renal cell carcinomas. | journal = J Urol | volume = 174 | issue = 4 Pt 1 | pages = 1199-202; discussion 1202 | month = Oct | year = 2005 | doi = | PMID = 16145369 }}</ref> | |||
***3% of >7 cm CCRCCs are limited to the kidney. | |||
***32% of 4.1-7.0 cm CCRCCs are limited to the kidney. | |||
*T2 is formally split into T2a (>7 cm and <=10 cm) and T2b (>10 cm); however, this subdivision does not appear to have prognostic valve.<ref name=pmid21030143>{{Cite journal | last1 = Waalkes | first1 = S. | last2 = Becker | first2 = F. | last3 = Schrader | first3 = AJ. | last4 = Janssen | first4 = M. | last5 = Wegener | first5 = G. | last6 = Merseburger | first6 = AS. | last7 = Schrader | first7 = M. | last8 = Hofmann | first8 = R. | last9 = Stöckle | first9 = M. | title = Is there a need to further subclassify pT2 renal cell cancers as implemented by the revised 7th TNM version? | journal = Eur Urol | volume = 59 | issue = 2 | pages = 258-63 | month = Feb | year = 2011 | doi = 10.1016/j.eururo.2010.10.005 | PMID = 21030143 }}</ref> | |||
====Renal sinus invasion==== | ====Renal sinus invasion==== | ||
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#Tumour within the loose connective tissue of the renal sinus. | #Tumour within the loose connective tissue of the renal sinus. | ||
===Lymph node stage=== | |||
{| class="wikitable sortable" | |||
! Stage | |||
! Characteristics | |||
! Comment | |||
|- | |||
| Nx | |||
| cannot be determined (no lymph nodes submitted or found) | |||
| most common | |||
|- | |||
| N0 | |||
| lymph nodes present and clear of tumour | |||
| uncommon | |||
|- | |||
| N1 | |||
| any number of lymph nodes with tumour | |||
| rare | |||
|} | |||
Notes: | Notes: | ||
Line 62: | Line 79: | ||
**Now only ''N1'' - was changed in 2009.<ref name=pmid21927698>{{Cite journal | last1 = Lee | first1 = C. | last2 = You | first2 = D. | last3 = Park | first3 = J. | last4 = Jeong | first4 = IG. | last5 = Song | first5 = C. | last6 = Hong | first6 = JH. | last7 = Ahn | first7 = H. | last8 = Kim | first8 = CS. | title = Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index. | journal = Korean J Urol | volume = 52 | issue = 8 | pages = 524-30 | month = Aug | year = 2011 | doi = 10.4111/kju.2011.52.8.524 | PMID = 21927698 }}</ref> | **Now only ''N1'' - was changed in 2009.<ref name=pmid21927698>{{Cite journal | last1 = Lee | first1 = C. | last2 = You | first2 = D. | last3 = Park | first3 = J. | last4 = Jeong | first4 = IG. | last5 = Song | first5 = C. | last6 = Hong | first6 = JH. | last7 = Ahn | first7 = H. | last8 = Kim | first8 = CS. | title = Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index. | journal = Korean J Urol | volume = 52 | issue = 8 | pages = 524-30 | month = Aug | year = 2011 | doi = 10.4111/kju.2011.52.8.524 | PMID = 21927698 }}</ref> | ||
***There is data to suggest N1 and N2 behave differently;<ref name=pmid16469567>{{Cite journal | last1 = Canfield | first1 = SE. | last2 = Kamat | first2 = AM. | last3 = Sánchez-Ortiz | first3 = RF. | last4 = Detry | first4 = M. | last5 = Swanson | first5 = DA. | last6 = Wood | first6 = CG. | title = Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome. | journal = J Urol | volume = 175 | issue = 3 Pt 1 | pages = 864-9 | month = Mar | year = 2006 | doi = 10.1016/S0022-5347(05)00334-4 | PMID = 16469567 }}</ref> however, it is disputed.<ref name=pmid17070225>{{Cite journal | last1 = Dimashkieh | first1 = HH. | last2 = Lohse | first2 = CM. | last3 = Blute | first3 = ML. | last4 = Kwon | first4 = ED. | last5 = Leibovich | first5 = BC. | last6 = Cheville | first6 = JC. | title = Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma. | journal = J Urol | volume = 176 | issue = 5 | pages = 1978-82; discussion 1982-3 | month = Nov | year = 2006 | doi = 10.1016/j.juro.2006.07.026 | PMID = 17070225 }}</ref><ref name=pmid19955666>{{Cite journal | last1 = Lam | first1 = JS. | last2 = Klatte | first2 = T. | last3 = Breda | first3 = A. | title = Staging of renal cell carcinoma: Current concepts. | journal = Indian J Urol | volume = 25 | issue = 4 | pages = 446-54 | month = | year = | doi = 10.4103/0970-1591.57906 | PMID = 19955666 }}</ref> | ***There is data to suggest N1 and N2 behave differently;<ref name=pmid16469567>{{Cite journal | last1 = Canfield | first1 = SE. | last2 = Kamat | first2 = AM. | last3 = Sánchez-Ortiz | first3 = RF. | last4 = Detry | first4 = M. | last5 = Swanson | first5 = DA. | last6 = Wood | first6 = CG. | title = Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome. | journal = J Urol | volume = 175 | issue = 3 Pt 1 | pages = 864-9 | month = Mar | year = 2006 | doi = 10.1016/S0022-5347(05)00334-4 | PMID = 16469567 }}</ref> however, it is disputed.<ref name=pmid17070225>{{Cite journal | last1 = Dimashkieh | first1 = HH. | last2 = Lohse | first2 = CM. | last3 = Blute | first3 = ML. | last4 = Kwon | first4 = ED. | last5 = Leibovich | first5 = BC. | last6 = Cheville | first6 = JC. | title = Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma. | journal = J Urol | volume = 176 | issue = 5 | pages = 1978-82; discussion 1982-3 | month = Nov | year = 2006 | doi = 10.1016/j.juro.2006.07.026 | PMID = 17070225 }}</ref><ref name=pmid19955666>{{Cite journal | last1 = Lam | first1 = JS. | last2 = Klatte | first2 = T. | last3 = Breda | first3 = A. | title = Staging of renal cell carcinoma: Current concepts. | journal = Indian J Urol | volume = 25 | issue = 4 | pages = 446-54 | month = | year = | doi = 10.4103/0970-1591.57906 | PMID = 19955666 }}</ref> | ||
===Metastasis stage=== | |||
*Discontinous tumour in the adrenal gland is M1. | |||
Notes: | |||
*Tumour nodules in the perinephric fat (without appreciable lymphoid tissue to suggest a lymph node) are T3a or T4. They likely represent [[in transit metastasis|in-transit metastases]] (known as [[tumour deposits]] in colorectal tumours); these are not specifically recorded in the current staging system. | |||
==See also== | ==See also== | ||
*[[Kidney tumours]]. | *[[Kidney tumours]]. | ||
*[[Sinus invasion]]. | *[[Sinus invasion]]. | ||
*[[Total nephrectomy for tumour grossing]]. | |||
*[[Partial nephrectomy grossing]]. | |||
==References== | ==References== |
Latest revision as of 15:18, 29 October 2021
The article deals with kidney cancer staging for renal cell carcinoma. A general discussion of staging is found in cancer staging.
General
- TNM staging used.
- Urothelial carcinoma of the kidney has a different staging system.
TNM staging system
Tumour stage
Stage | Characteristics | Comments |
---|---|---|
T1a | <=4 cm, confined to kidney | common |
T1b | >4 cm and <=7 cm, confined to kidney | uncommon |
T2 | >7 cm, confined to kidney | rare - most large tumours are T3a |
T3a | any size with sinus invasion (see below) or perinephric invasion | very common |
T3b | tumour in a caval thrombus below the diaphragm without invasion or adherence to the wall of the cava | very uncommon |
T3c | tumour in a caval thrombus above the diaphgram or with invasion or adherence to the wall of the cava | very uncommon |
T4 | direct invasion into the adrenal gland or extension beyond Gerota's fascia | discontinuous spread into the adrenal gland is a M1, extension beyond Gerota's fascia is rare |
Notes:
- Most cases are pT1a or pT3a.
- T2 is formally split into T2a (>7 cm and <=10 cm) and T2b (>10 cm); however, this subdivision does not appear to have prognostic valve.[2]
Renal sinus invasion
Renal sinus invasion is when any of the following are present:[3]
- Tumour in an endothelial lined space of the renal sinus.
- Tumour touching renal sinus fat.
- Tumour within the loose connective tissue of the renal sinus.
Lymph node stage
Stage | Characteristics | Comment |
---|---|---|
Nx | cannot be determined (no lymph nodes submitted or found) | most common |
N0 | lymph nodes present and clear of tumour | uncommon |
N1 | any number of lymph nodes with tumour | rare |
Notes:
- Previously divided into N1 (one lymph node positive) and N2 (multiple lymph nodes positive).
Metastasis stage
- Discontinous tumour in the adrenal gland is M1.
Notes:
- Tumour nodules in the perinephric fat (without appreciable lymphoid tissue to suggest a lymph node) are T3a or T4. They likely represent in-transit metastases (known as tumour deposits in colorectal tumours); these are not specifically recorded in the current staging system.
See also
- Kidney tumours.
- Sinus invasion.
- Total nephrectomy for tumour grossing.
- Partial nephrectomy grossing.
References
- ↑ Bonsib, SM. (Oct 2005). "T2 clear cell renal cell carcinoma is a rare entity: a study of 120 clear cell renal cell carcinomas.". J Urol 174 (4 Pt 1): 1199-202; discussion 1202. PMID 16145369.
- ↑ Waalkes, S.; Becker, F.; Schrader, AJ.; Janssen, M.; Wegener, G.; Merseburger, AS.; Schrader, M.; Hofmann, R. et al. (Feb 2011). "Is there a need to further subclassify pT2 renal cell cancers as implemented by the revised 7th TNM version?". Eur Urol 59 (2): 258-63. doi:10.1016/j.eururo.2010.10.005. PMID 21030143.
- ↑ Trpkov, K.; Grignon, DJ.; Bonsib, SM.; Amin, MB.; Billis, A.; Lopez-Beltran, A.; Samaratunga, H.; Tamboli, P. et al. (Oct 2013). "Handling and staging of renal cell carcinoma: the International Society of Urological Pathology Consensus (ISUP) conference recommendations.". Am J Surg Pathol 37 (10): 1505-17. doi:10.1097/PAS.0b013e31829a85d0. PMID 24025521.
- ↑ Lee, C.; You, D.; Park, J.; Jeong, IG.; Song, C.; Hong, JH.; Ahn, H.; Kim, CS. (Aug 2011). "Validation of the 2009 TNM Classification for Renal Cell Carcinoma: Comparison with the 2002 TNM Classification by Concordance Index.". Korean J Urol 52 (8): 524-30. doi:10.4111/kju.2011.52.8.524. PMID 21927698.
- ↑ Canfield, SE.; Kamat, AM.; Sánchez-Ortiz, RF.; Detry, M.; Swanson, DA.; Wood, CG. (Mar 2006). "Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome.". J Urol 175 (3 Pt 1): 864-9. doi:10.1016/S0022-5347(05)00334-4. PMID 16469567.
- ↑ Dimashkieh, HH.; Lohse, CM.; Blute, ML.; Kwon, ED.; Leibovich, BC.; Cheville, JC. (Nov 2006). "Extranodal extension in regional lymph nodes is associated with outcome in patients with renal cell carcinoma.". J Urol 176 (5): 1978-82; discussion 1982-3. doi:10.1016/j.juro.2006.07.026. PMID 17070225.
- ↑ Lam, JS.; Klatte, T.; Breda, A.. "Staging of renal cell carcinoma: Current concepts.". Indian J Urol 25 (4): 446-54. doi:10.4103/0970-1591.57906. PMID 19955666.