Kidney cancer staging
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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.