After someone is diagnosed with kidney cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent of the cancer in the body. It helps determine how serious the cancer is and how best to treat it.
The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be. To determine the cancer’s stage after a kidney cancer diagnosis, doctors try to answer these questions:. How large has the cancer grown in the kidney?. Has the cancer reached nearby structures, such as major blood vessels?.
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Has the cancer spread to the nearby lymph nodes or to distant organs? The stage of kidney cancer is based on the results of the physical exam, imaging tests (CT scan, chest x-ray, PET scan, etc.), and sometimes biopsies which are described in Understanding your kidney cancer stage After looking at your test results, your doctor will tell you the stage of your cancer. The staging system most often used for kidney cancer is the American Joint Committee on Cancer (AJCC) TNM system. The TNM system is based on 3 key pieces of information:. The size of the main (primary) tumor ( T) and whether it has grown into nearby areas.
If the cancer has spread to nearby (regional) lymph nodes ( N). Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread first. If the cancer has spread ( metastasized) to other organs ( M). Kidney cancer can spread almost anywhere in the body, but common sites of spread are the bones, brain, and lungs. Numbers or letters after T, N, and M provide more details about each of these factors.
Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.
The earliest stage cancers are called stage 0 (carcinoma in situ), and then range from stages I (1) through IV (4). Some of the stages have sub-stages with the letters A, B, and C.
The letter X means “cannot be assessed because the information is not available.” As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage.
Cancers with similar stages tend to have a similar outlook and are often treated in much the same way. Patients with lower stage numbers tend to have a better prognosis. The staging system in the table below uses the pathologic stage. It is based on the results of physical exam, biopsy, imaging tests, and the results of surgery.
This is likely to be more accurate than clinical staging, which only considers the tests done before surgery. Kidney cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand. (An explanation of the TNM system also follows the stage table below.) Stage Stage grouping Stage description I T1, N0, M0 The tumor is 7 cm across or smaller and is only in the kidney (T1).
There is no spread to lymph nodes (N0) or distant organs (M0). II T2, N0, M0 The tumor is larger than 7 cm across but is still only in the kidney (T2).
There is no spread to lymph nodes (N0) or distant organs (M0). III T3, N0, M0 The tumor is growing into a major vein (like the renal vein or the vena cava) or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota’s fascia (T3). There is no spread to lymph nodes (N0) or distant organs (M0).
OR T1 to T3, N1, M0 The main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota’s fascia. The cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0). IV T4, Any N, M0 The main tumor is growing beyond Gerota’s fascia and may be growing into the adrenal gland on top of the kidney (T4). It may or may not have spread to nearby lymph nodes (any N).
It has not spread to distant lymph nodes or other organs (M0). OR Any T, Any N, M1 The main tumor can be any size and may have grown outside the kidney (any T). It may or may not have spread to nearby lymph nodes (any N).
It has spread to distant lymph nodes and/or other organs (M1). Explaining the TNM system T categories for kidney cancer TX: The primary tumor cannot be assessed (information not available). T0: No evidence of a primary tumor. T1: The tumor is only in the kidney and is no larger than 7 centimeters (cm), or a little less than 3 inches, across. T1a: The tumor is 4 cm (about 1½ inches) across or smaller and is only in the kidney. T1b: The tumor is larger than 4 cm but not larger than 7 cm across and is only in the kidney. T2: The tumor is larger than 7 cm across but is still only in the kidney.
T2a: The tumor is more than 7 cm but not more than 10 cm (about 4 inches) across and is only in the kidney. T2b: The tumor is more than 10 cm across and is only in the kidney. T3: The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland (on top of the kidney) or beyond Gerota’s fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue). T3a: The tumor is growing into the main vein leading out of the kidney (renal vein) or into fatty tissue around the kidney.
T3b: The tumor is growing into the part of the large vein leading into the heart (vena cava) that is within the abdomen. T3c: The tumor has grown into the part of the vena cava that is within the chest or it is growing into the wall of the vena cava. T4: The tumor has spread beyond Gerota’s fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue). The tumor may have grown into the adrenal gland (on top of the kidney). N categories for kidney cancer NX: Regional (nearby) lymph nodes cannot be assessed (information not available).
N0: No spread to nearby lymph nodes. N1: Tumor has spread to nearby lymph nodes. M categories for kidney cancer M0: There is no spread to distant lymph nodes or other organs.
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M1: Distant metastasis is present; includes spread to distant lymph nodes and/or to other organs. Kidney cancer most often spreads to the lungs, bones, liver, or brain. Other staging and prognostic systems The TNM staging system is useful, but some doctors have pointed out that there are factors other than the extent of the cancer that should be considered when determining prognosis and treatment. University of California Los Angeles (UCLA) Integrated Staging System This is a more complex system that came out in 2001. It was meant to improve upon the AJCC staging that was then in place. Along with the stage of the cancer, it takes into account a person’s overall health and the of the tumor.
These factors are combined to put people into low-, intermediate-, and high-risk groups. Ask your doctor if he or she uses this system and how it might apply to you. Survival predictors The stage of the cancer is an important predictor of survival, but other factors are also important. For example, researchers have linked certain factors with shorter survival times in people with kidney cancer that has spread outside the kidney. These include:. High blood lactate dehydrogenase (LDH) level. High blood calcium level.
Anemia (low red blood cell count). Cancer spread to 2 or more distant sites.
Less than a year from diagnosis to the need for systemic treatment (, or ). Poor performance status (a measure of how well a person can do normal daily activities) People with none of the above factors are considered to have a good prognosis; 1 or 2 factors are considered intermediate prognosis, and 3 or more of these factors are considered to have a poor prognosis and may be less likely to benefit from certain treatments. American Joint Committee on Cancer. AJCC Cancer Staging Manual. New York, NY. Springer; 2010:479-486. Clinical manifestations, evaluation, and staging of renal cell carcinoma; This topic last updated: Jan 19, 2017.
Accessed at on May 25, 2017. Lane BR, Canter DJ, Rini BI, Uzzo RG. Ch 63 - Cancer of the kidney. In: DeVita VT, Hellman S, Rosenberg SA, eds.
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Cancer: Principles and Practice of Oncology. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer. Accessed at: www.nccn.org on June 5, 2017. Pili R, Kauffman E, Rodriguez R.
Ch 82 - Cancer of the kidney. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. Philadelphia, Pa: Elsevier: 2014.
AJCC Cancer Staging Posters are ideal for display in pathology departments, dictation areas, medical record/chart completion areas, physician offices, cancer registries and at cancer conferences (tumor boards). The posters are available as downloadable PDF files and can be easily printed on 8.5x11 paper. Medium and large-sized posters can be printed at a professional print shop. The Cancer Staging Posters include the TNM classification, stage grouping and anatomic drawings for seven cancer sites.
From the AJCC Cancer Staging Manual prepared by the American Joint Committee on Cancer, the AJCC Cancer Staging Handbook contains the complete text of the Manual conveniently sized to fit in the pocket of a lab coat for complete portability. Used by physicians and health care professionals world wide, the Seventh Edition of the AJCC Cancer Staging Handbook brings together all the currently available information on staging of cancer at various anatomic sites and incorporates newly acquired knowledge on the etiology and pathology of cancer. As knowledge of cancer biology expands, cancer staging must incorporate these advances. Organized by disease site into 57 comprehensive chapters, the Seventh Edition features much-anticipated, major revisions to many chapters including breast, colon, prostate, kidney, and others. There are new primary site chapters for extrahepatic bile ducts, distal bile duct, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and the adrenal gland plus a vastly expanded section on ophthalmologic malignancies. From the reviews of the seventh edition:“Provide a new organ-specific classification that oncologists and other professionals who manage patients with cancer need in order to accurately classify tumours for staging. A ‘Bible’ for oncologists, pathologists and surgeons, being also useful for all health officers, including general physicians and students, who want to remain updated in oncology.
This is a book that has to be present in all diagnostic imaging departments, as a major support to produce information adequate to the new oncology algorithms.” (Vincenzo Cuccurullo and Luigi Mansi, European Journal of Nuclear Medicine and Molecular Imaging, Vol.
Notes.Note 1:. SEER.RSA added additional information to UICC 7th edition stages with UICC approval. If your registry submits the directly assigned Stage Groups to agencies other than SEER, please check the AJCC 7th edition manual to ensure you are using the appropriate logic.Note 2:. The stage group below is valid in UICC 7th edition, but not AJCC 7th edition.
Stage Group III - (T3, T3a, T3b), NX, M0.Note 3:. While the stage group below is valid, the specified TNM combination is only included in SEER.RSA. Stage Group III - T0, N1, M0 - T0 is not included in the stage group definition.Note 4:.
TNM does not include an in situ category for this schema. Assign 88 to stage group for in situ cases.
The American Joint Committee on Cancer and the International Union for Cancer Control update the tumor-node-metastasis (TNM) cancer staging system periodically. The most recent revision is the 7th edition, effective for cancers diagnosed on or after January 1, 2010. This editorial summarizes the background of the current revision and outlines the major issues revised. Most notable are the marked increase in the use of international datasets for more highly evidenced-based changes in staging, and the enhanced use of nonanatomic prognostic factors in defining the stage grouping. The future of cancer staging lies in the use of enhanced registry data standards to support personalization of cancer care through cancer outcome prediction models and nomograms.
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