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Stages of Kidney Cancer

Definition of Staging

A staging system lets doctors know if the cancer has spread and to what extent. Staging describes the extent or severity of cancer based on the size of the original (primary) tumor and the extent to which it has spread in the body. There are several staging systems for prostate cancer but the most widely used system in the United States is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer (AJCC).¹

General Information on Staging

Staging is based on knowledge of how cancer develops. Cancer cells divide and grow to form a mass of tissue called a growth or tumor. As a tumor grows, it can spread to nearby organs and tissues. Cancer cells may also break away from the tumor and enter the bloodstream or lymphatic system. By moving through the bloodstream or lymphatic system, cancer can spread from the primary site to form new tumors in other organs. The spread of cancer is called metastasis.

Purpose of Staging

Staging helps with the cancer diagnosis and treatment process in important ways, including:

• Helping the doctors to effectively plan a patient's treatment
• Estimating the patient's prognosis (likely outcome or course of the disease)
• Helping to identify clinical trials that may be suitable for a particular patient.¹

Staging helps researchers and health care providers exchange information about patients and provide a common language for diagnosis, treatment and clinical trials.

Staging Kidney Cancer

The AJCC staging system includes the primary kidney tumor (T stage), the lymph nodes near the kidney (N stage) and the presence or absence of metastases (M stage) to determine if the cancer has spread. In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery. Pathologic stage is based on the analysis of the tissue that has been surgically

Stages

Stage I

The tumor is confined to the kidney. There is no spread to lymph nodes or distant organs.

Stage II

The tumor has invaded the fat around the kidney or the adrenal gland above the kidney. There is no spread to lymph nodes or other organs.

Stage III

There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade other nearby organs or more distant organs.

Stage IV

There are several combinations of T, N, and M categories included in this stage. This stage includes any cancers that have invaded into nearby organs such as the colon (large bowel) or the abdominal wall as well as more distant organs in the body.

Primary Tumor (T):

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor 7.0 cm or less, confined to the kidney

T1a

Tumor 4.0 cm or less, confined to the kidney

T1b

Tumor 4.0-7.0 cm, confined to the kidney

T2

Tumor greater than 7.0 cm, limited to kidney

T3

Tumor extends into major veins/adrenal/tissue; not beyond Gerota's fascia

T3a

Tumor invades adrenal/perinephric fat

T3b

Tumor extends into renal vein(s) or vena cava below diaphragm

T3c

Tumor extends into vena cava above diaphragm

T4

Tumor invades beyond Gerota's fascia, into adjacent organ systems.

N - Regional Lymph Nodes

NX

Regional nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in a single regional lymph node

N2

Metastasis in more than one regional lymph node

M - Distant Metastasis

MX

Distant metastasis cannot be assessed

M0

No distant metastasis

M1

Distant metastasis

In general, cancers with higher T stage, lymph node metastasis, or distant metastasis have a worse prognosis and shorter survival rates; these patients need to consider more aggressive treatments.²