Kidney cancer staging

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Schematic showing a T1 kidney cancer. (WC/CRUK)

The article deals with kidney cancer staging. A general discussion of staging is found in cancer staging.

General

  • TNM staging used.

TNM staging system

Tumour stage

Stage Characteristics Comments
T1a <=4 cm, confined to kidney common
T1b >4 cm and <=7 cm, confined to kidney
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 uncommon
T3c tumour in a caval thrombus above the diaphgram or with invasion or adherence to the wall of the cava 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

Note:

  • 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.

Renal sinus invasion

Renal sinus invasion is when any of the following are present:[1]

  1. Tumour in an endothelial lined space of the renal sinus.
  2. Tumour touching renal sinus fat.
  3. Tumour within the loose connective tissue of the renal sinus.

Notes:

  • Most cases are pT1a or pT3a.
    • pT2 is very rare and pT1b is uncommon for CCRCC - in a series of 120 cases:[2]
      • 3% of >7 cm CCRCCs are limited to the kidney.
      • 32% of 4.1-7.0 cm CCRCCs are limited to the kidney.

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).
    • Now only N1 - was changed in 2009.[3]
      • There is data to suggest N1 and N2 behave differently;[4] however, it is disputed.[5][6]

See also

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
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