Renal cell carcinoma (TNM staging)

The TNM system may be used for staging of renal cell carcinoma. An older but still widely used system for staging of renal cell carcinoma in some practices is the Robson staging system.

TNM staging (8^th edition)

Primary tumor staging (T)

• Tx: tumor cannot be assessed

• T0: tumor not seen

• T1

  • T1a: tumor confined to kidney, <4 cm

  • T1b: tumor confined to kidney, >4 cm but <7 cm

• T2: limited to kidney >7 cm

  • T2a: tumor confined to kidney, >7 cm but not >10 cm

  • T2b: tumor confined to kidney, >10 cm

• T3: tumor extension into major veins or perinephric tissues, but not into ipsilateral adrenal gland or 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 the Gerota fascia

  • T3b: spread to infra diaphragmatic IVC

  • T3c: spread to supra diaphragmatic IVC or invades the wall of the IVC

• T4: involves ipsilateral adrenal gland or invades beyond Gerota's fascia

Regional lymph nodes (N)

• N0: no nodal involvement

• N1: metastatic involvement of regional lymph node(s)

Metastases (M)

• M0: no distant metastases

• M1: distant metastases

Stage groupings

• stage I: T1 N0 M0

• stage II: T2 N0 M0

• stage III: T3 or N1 with M0

• stage IV: T4 or M1

Notes

• the distinction between N1 and N2 was discontinued in the most recent version of staging

• contiguous involvement of the ipsilateral adrenal gland is T4, noncontiguous involvement is M1

• the most common sites of metastasis are, in order: the lungs, the bones, lymph nodes, the liver, adrenals and the brain ⁷