Kidney cancer staging

From Libre Pathology
Jump to navigation Jump to search
Schematic showing a T1 kidney cancer. (WC/CRUK)
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.


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


  • Most cases are pT1a or pT3a.
    • pT2 is very rare and pT1b is uncommon for CCRCC - in a series of 120 cases:[1]
      • 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.[2]

Renal sinus invasion

Renal sinus invasion is when any of the following are present:[3]

  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.

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


  • Previously divided into N1 (one lymph node positive) and N2 (multiple lymph nodes positive).
    • Now only N1 - was changed in 2009.[4]
      • There is data to suggest N1 and N2 behave differently;[5] however, it is disputed.[6][7]

Metastasis stage

  • Discontinous tumour in the adrenal gland is M1.


  • 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


  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.