Renal Cell Carcinoma

Staging

As with all cancers, identifying the stage of RCC is essential for determining the prognosis (likely outcome) and for planning treatment. Staging helps doctors describe where the cancer is located, if and where it has spread, and whether other organs in the body are affected by it.

RCC is usually staged twice. First, your doctor will evaluate the results of your physical exam and imaging tests and assign a clinical stage. Then, after a staging procedure or surgical resection is done, a pathologist will examine tissue taken from the tumor and nearby lymph nodes and assign a pathologic stage, which provides more details about the cancer. The enhanced accuracy of the pathologic stage is important to determine the best treatment options and predict the prognosis.

RCC is classified according to the tumor, node, metastasis (TNM) system developed by the American Joint Committee on Cancer (AJCC) and the International Union against Cancer (UICC). TNM is an acronym for tumor (T), node (N) and metastasis (M). Doctors categorize the tumor according to its size and location (T), whether cancer cells are found in nearby lymph nodes (N) and whether the cancer has spread – or metastasized – to other parts of the body (M) (Table 1). Once an RCC has been classified with the TNM system, an overall stage is assigned (Table 2). The lower the stage, the smaller the tumor and the less the cancer has spread. The higher the stage, the larger the tumor and the more the cancer has spread.

The Fuhrman grade of cancer is also an important tool in assessing RCC. The grade refers to how closely the cancer cells resemble normal cells under the microscope. The graded scale ranges from 1 to 4, with 1 representing cancer cells that look similar to normal cells and 4 representing cancer cells that look vastly different from normal cells. The lower the grade, the better the outlook for the patient.

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Metastatic RCC

If the RCC is diagnosed as Stage IV, it’s considered metastatic, which means it has spread from the kidney to another part of the body, called a metastatic site. The most common metastatic sites for RCC are the lungs, lymph nodes, bones, brain, liver and adrenal glands.

Metastatic tumors have the same type of abnormal cells as the primary (original) tumor and are referred to by the same name. So if RCC metastasizes to the liver, for example, the cancer cells in the liver are still RCC cells and the disease is called metastatic RCC rather than liver cancer. It is also treated as RCC, not as liver cancer.

Throughout the diagnosis and staging process, keep an open dialogue with your health care team and ask any questions you may have so you can truly understand your specific cancer and the best options for you.

Table 1. TNM classification for RCC

Classification Definition
Tumor (T)  
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor is less than 7 cm (approximately 3 inches) in greatest dimension, limited to the kidney
T1a Tumor is less than 4 cm (approximately 1.5 inches) in greatest dimension, limited to the kidney
T1b Tumor is greater than 4 cm (approximately 1.5 inches) but less than 7 cm (approximately 3 inches) in dimension, limited to the kidney
T2 Tumor is greater than 7 cm (approximately 3 inches) in greatest dimension, limited to the kidney
T2a Tumor is greater than 7 cm (approximately 3 inches) but less than 10 cm (approximately 4 inches) in greatest dimension, limited to the kidney
T2b Tumor is greater than 10 cm (approximately 4 inches), limited to the kidney
T3 Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia
T3a Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota’s fascia
T3b Tumor grossly extends into the vena cava below the diaphragm
T3c Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava
T4 Tumor invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)
Nodes (N)  
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastases in regional lymph node(s)
Metastasis (M)  
M0 No distant metastasis
M1 Distant metastasis

Table 2: Stages of RCC

Stage TNM classifications Description
Stage I T1, N0, M0 Cancer cells are confined to the kidney, and the tumor is smaller than a tennis ball (less than 3 inches or 7 centimeters).
Stage II T2, N0, M0 Cancer cells are confined to the kidney, but the tumor is larger than a tennis ball.
Stage III T1/T2, N1, M0
T3, N0/N1, M0
Cancer cells have spread to at least one nearby lymph node. Or the tumor, which can be any size, has grown through the kidney and reached nearby blood vessels.
Stage IV T4, Any N, M0
Any T, Any N, M1
Cancer cells have spread to nearby lymph nodes or to other metastatic sites, including the lungs, liver, bones or other tissues. Or the tumor has grown through the kidney’s surrounding layers of fatty and fibrous tissues.

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