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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== | ||
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! Comments | ! Comments | ||
|- | |- | ||
| T1a | | T1a | ||
| <=4 cm, confined to kidney | | <=4 cm, confined to kidney | ||
| common | | common | ||
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| 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 | ||
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| 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 | ||
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|} | |} | ||
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 touching renal sinus fat. | #Tumour touching renal sinus fat. | ||
#Tumour within the loose connective tissue of the renal sinus. | #Tumour within the loose connective tissue of the renal sinus. | ||
===Lymph node stage=== | ===Lymph node stage=== | ||
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*[[Kidney tumours]]. | *[[Kidney tumours]]. | ||
*[[Sinus invasion]]. | *[[Sinus invasion]]. | ||
*[[ | *[[Total nephrectomy for tumour grossing]]. | ||
*[[Partial nephrectomy grossing]]. | |||
==References== | ==References== |
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