Conditions

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 removed.

Stage	Explanation / Description
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

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¹"Staging: Questions and Answers," National Cancer Institute. www.cancer.gov. URL: http://www.cancer.gov/cancertopics/factsheet/Detection/staging
²"Kidney Cancer", American Urological Association Foundation. Urologyhealth.org. URL http://urologyhealth.org/adult/index.cfm?cat=04&topic=124:

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