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Renal Cell Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Renal Cell Cancer

The staging system for renal cell cancer is based on the degree of tumor spread beyond the kidney.[1,2,3] Involvement of blood vessels may not be a poor prognostic sign if the tumor is otherwise confined to the substance of the kidney. Abnormal liver function test results may be caused by a paraneoplastic syndrome that is reversible with tumor removal, and these types of results do not necessarily represent metastatic disease. Except when computed tomography (CT) examination is equivocal or when iodinated contrast material is contraindicated, CT scanning is as good as or better than magnetic resonance imaging for detecting renal masses.[4]

Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define renal cell cancer.[5]

Table 1. Primary Tumor (T)a

a Reprinted with permission from AJCC: Kidney. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 479-89.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
T1Tumor ≤7 cm in greatest dimension, limited to the kidney.
T1aTumor ≤4 cm in greatest dimension, limited to the kidney.
T1bTumor >4 cm but not >7 cm in greatest dimension, limited to the kidney.
T2Tumor >7 cm in greatest dimension, limited to the kidney.
T2aTumor >7 cm but ≤10 cm in greatest dimension, limited to the kidney.
T2bTumor >10 cm, limited to the kidney.
T3Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota fascia.
T3aTumor 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 fascia.
T3bTumor grossly extends into the vena cava below the diaphragm.
T3cTumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava.
T4Tumor invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal gland).

Table 2. Regional Lymph Nodes (N)a

a Reprinted with permission from AJCC: Kidney. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 479-89.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastases in regional lymph node(s).
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