The staging system of the American Joint Committee on Cancer for renal cell carcinoma can be used to describe the extent of disease in a patient. The version proposed in 1987 was modified in 1997.
1987 Version
|
Extent of Disease |
Additional Findings |
TNM |
|
primary cannot be assessed |
|
TX |
|
no evidence of primary tumor |
|
T0 |
|
confined within the renal capsule |
size <= 2.5 cm in greatest dimension |
T1 N0 M0 |
|
|
size > 2.5 cm |
T2 N0 M0 |
|
extending through the renal capsule but confined by Gerota's fascia |
invades ipsilateral adrenal gland or perinephric tissue |
T3a N0 M0 |
|
involvement of major veins |
renal vein or inferior vena cava below diaphragm |
T3b N0 M0 |
|
|
inferior vena cava above diaphragm |
T3c N0 M0 |
|
regional lymph node involvement |
cannot be assessed |
NX |
|
|
single node <= 2 cm in greatest dimension |
T1-3a N1 M0 |
|
|
single node > 2 cm and <= 5 cm multiple lymph nodes all <= 5 cm |
T1-3a N2 M0 |
|
|
node > 5cm in greatest dimension |
T1-3a N3 M0 |
|
extension into adjacent organs by direct invasion (other than ipsilateral adrenal gland) |
|
T4 any N M0 |
|
distant metastasis |
cannot be assessed |
MX |
|
|
present |
any T any N M1 |
where:
• Gerota's fascia delimits the perinephric fat
|
T |
N |
M |
Stage |
|
T1 |
N0 |
M0 |
I |
|
T2 |
N0 |
M0 |
II |
|
T1 T2 T3a T3a T3b T3b T3c T3c |
N1 N1 N0 N1 N0 N1 N0 N1 |
M0 M0 M0 M0 M0 M0 M0 M0 |
III |
|
T4 any T any T any T |
any N N2 N3 any N |
M0 M0 M0 M1 |
IV |
Modification from 1997
This system was modified in 1997 with the tumor size for T1 vs T2 lesions being increased from 2.5 to 7.0 cm (see Javidan, 1999). This increases the relative number of patients placed as T1 (and Stage I) lesions.
This modification is equivalent to the 1987 scheme in predicting outcome, but it does a better job of stratifying cases according to survival.
Specialty: Hematology Oncology, Surgery, general, Nephrology
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