TNM_RCC v.1
The American Joint Committee on Cancer (AJCC) TNM staging system reports on the severity of renal cell cancer based on tumor, lymph node and metastasis characteristics.
The American Joint Committee on Cancer (AJCC) TNM staging system reports on the severity of renal cell cancer based on tumor, lymph node and metastasis characteristics. The characteristics of the size of the tumour, the extent of spread to local lymph nodes and body organs. These aspects are captured in 3 ways that make up the mnemonic TNM: T: Tumour size; N: Number of regional lymph nodes affected and M: whether the cancer has spread/metastasised beyond the primary organs and regional nodes. Each major category is further subdivided to help classify the picture further. These subdivisions are given suffixes or numbered as shown below. This staging system does not deal with cancers in the renal pelvis.
Staging is based on multiple factors including: •Primary tumor (T) characteristics •Regional lymph nodes (N) o Clinical o Pathological •Distant metastasis (M) Staging: Stage 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). Stage 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). Stage III: Either of the following: 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). 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). Stage IV: Either of the following: 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). 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). The acronyms, T, N and M are subdivided into subsections and lettered as shown below: T 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 NX: Regional (nearby) lymph nodes cannot be assessed (information not available). N0: No spread to nearby lymph nodes. N1: Tumor has spread to one nearby lymph node N2: Tumor has spread to nearby lymph nodes. M MX: Distant lymph nodes cannot be assessed M0: There is no spread to distant lymph nodes or other organs. 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.
The interpretation of the staging system using the TNM has not been fully validated for use in determining the management of RCC (renal cell carcinoma) and further clarification maybe needed using other systems such as the University of California Los Angeles (UCLA) Integrated Staging System and other Survival predictors. Thus on its own, the TNM can not be used for individual prediction but used as a more general guide.
Ref. 1: Kidney. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. Ref. 2: Escudier B, et al. Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol (2014) 25 (suppl 3): iii49-iii56.
OBSERVATION.tnm_renal_cell_carcinoma_staging.v1, EVALUATION.tnm_rcc_assessment.v1
