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What are the Stages and Grading of Kidney Cancer

Kidney Cancer Stage 1
Kidney Cancer Stage 1
Cancer Research UK

Kidney Cancer Stage 2
Kidney Cancer Stage 2
Cancer Research UK

Kidney Cancer Stage 3
Kidney Cancer Stage 3
Cancer Research UK

Kidney Cancer Stage 4
Kidney Cancer Stage 4
Cancer Research UK

For more information on the TNM system and kidney cancer staging, click here.

If cancer cells are found, your doctor will need to know the tumor stage and grade. The stage is a category used to rank how much the cancer has grown and/or spread. For kidney cancer, the “TNM” staging system is often used. The grade is a way to rank how quickly the cancer is growing. The Fuhrman grading system is often used. A carefully diagnosed grade and stage will help your health care team find the best treatment.

Staging

The American Joint Committee on Cancer (AJCC) is the most common kidney cancer staging system used. For kidney cancer, this system is known as the TNM system. It describes three pieces of information:

  • T describes the size of the main (primary) tumor and whether it has grown into nearby areas.
  • N describes how much it has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-sized collections of immune system cells.
  • M describes whether the cancer has spread (metastasized) to other parts of the body. The most common sites of spread are to the lungs, bones, liver, brain, and distant lymph nodes.

Numbers or letters provide more details about each of these factors. The grades 0 through 4 show increasing severity. The letter X means “not enough information is available.”

Staging the cancer helps to predict your long-term health and survival. For example, cancers with higher T stage, lymph node or other metastasis have a worse outcome. These patients may want to consider other treatments.

These descriptions define the main kidney cancer stages:

  • Stage I: The tumor is confined to the kidney and less than 7.0 cm in size. There is no spread to lymph nodes or distant organs.
  • Stage II: The tumor is confined to the kidney and greater than 7.0 cm in size. There is no spread to lymph nodes or distant organs.
  • Stage III: There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade into other adjacent organs or those with distant metastasis.
  • Stage IV: There are several combinations of T, N, and M categories that are included in this stage. This stage includes any cancers that have invaded into adjacent organs such as the colon (large bowel) or the abdominal wall, and those with distant metastases.

TNM Staging Categories

Primary tumor (T):
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: Tumor 7.0 cm or less, confined to the kidney
T1a: Tumor 4.0 cm or less, confined to the kidney
T1b: Tumor 4.0-7.0 cm, confined to the kidney
T2: Tumor greater than 7.0 cm, limited to kidney
T2a: Tumor > 7 cm and less than 10.0 cm, confined to the kidney
T2b: Tumor > 10 cm, confined to the kidney
T3: Tumor extends into major veins or perinephric tissues but not into the adrenal gland and not beyond Gerota's fascia
T3a: Tumor extends in the renal vein or its segmental branches, or tumor invades perirenal and or renal sinus fat but not beyond Gerota's fascia
T3b: Tumor extends into the vena cava below the diaphragm
T3c: Tumor extends into vena cava above diaphragm or invades the wall of the diaphragm
T4: Tumor invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland

N - Regional lymph nodes
NX: Regional nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in regional lymph node(s)

M - Distant metastasis
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis