Renal Cell Carcinoma TNM Staging

According to the TNM* staging system: T = Tumor, N = Node (lymph node), M = Metastasis

Tumor (T) Categorizations

T1 — Tumor is 7 centimeters (cm) or less in greatest dimension, limited to the kidney

T1a (left) — Tumor 4 cm (1.6”) or less in greatest dimension, limited to the kidney
T1b (right) — Tumor more than 4 cm but not more than 7 cm (2.8”), in greatest dimension, limited to the kidney

T2 — Tumor is more than 7 centimeters (cm) in greatest dimension, limited to the kidney

T2a and 2b

T2a (left) — Tumor more than 7 cm but less than or equal to 10 cm (3.9”) in greatest dimension, limited to the kidney
T2b (right) — Tumor more than 10 cm, 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 and 3b

T3a1 (upper left) — Tumor invades perirenal and/or renal sinus fat but not beyond Gerota’s fascia
T3a2 (upper right) — Tumor grossly extends into the renal vein or its segmental (muscle containing) branches
T3b (lower left) — Tumor grossly extends into the vena cava below the diaphragm
T3c (lower right) — 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 or into the adrenal gland

T4a and 4b

T4a (left) —Tumor invades beyond Gerota’s fascia
T4b (right) —Tumor extends into the ipsilateral adrenal gland

Lymph Node (N) Categorizations

NX — Regional lymph nodes cannot be assessed
N0 — No regional lymph node metastasis
N1 — Metastasis in regional lymph node(s)

Metastasis (M) Categorizations

M0 — No distant metastasis
M1 — Distant metastasis

Anatomic Stages

Stage I — T1 | N0 | M0
Stage II — T2 | N0 | M0
Stage III — T1 or T2 | N1 | M0 …or… T3 | N0 or N1 | M0
Stage IV — T4 | any N | M0 …or… any T | any N | M1

Source: American Joint Committee on Cancer (AJCC)*

Histologic Grade

The grades run from 1 to 4 depending on the appearance of the tumor cells. Normal cells are well formed (differentiated). The less differentiated the cell, the higher the grade.
G1 — Well Differentiated
G2 — Moderately Differentiated
G3 — Poorly Differentiated
G4 — Undifferentiated

Source: American Joint Committee on Cancer (AJCC)*

Survival Rates

Five-Year Relative Survival Rates (%) by Stage at Diagnosis (2001-2007)
All Stages — 70%
Local — 91%
Regional — 63%
Distant — 11%

Source: American Cancer Society Cancer Facts and Figures 2012. Note: Although these are the latest data available, these figures were gathered before targeted therapies came into widespread use. Survival times for metastatic patients are better now.

View Human Urinary System and Kidney Physiology

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*Descriptions used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Handbook, Seventh Edition (2010) published by Springer Science and Business Media LLC, www.springerlink.com.

Illustrations: Kimberly Battista