Renal cell carcinoma (TNM staging)

Dr Derek Smith ◉ and Dr Vinod G Maller et al.

Renal cell carcinoma staging using the TNM staging system for renal cell carcinoma. Older but still widely used system in some practices is the Robson staging system.

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

N

N0: no nodal involvement
N1: metastatic involvement of regional lymph node(s)

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