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Kidney tumor

Adult malignancies - Miscellaneous

Staging


Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 12 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Excludes sarcomas, adenomas, tumors of renal pelvis/ureter, Wilms’ tumor of childhood
● Reference: AJCC Cancer Staging Manual (7th ed)

Primary tumor (T)

General
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TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: Tumor 7 cm or less (in greatest dimension), limited to kidney
T1a: Tumor 4 cm or less, limited to kidney
T1b: Tumor more than 4 cm, not more than 7 cm, limited to kidney
T2: Tumor more than 7 cm, limited to kidney
T2a: Tumor more than 7 cm but less than or equal to 10 cm, limited to kidney
T2b: Tumor more than 10 cm, limited to kidney
T3: Tumor extends into major veins or perinephric tissue, but not into the ipsilateral adrenal grand and not beyond Gerota’s fascia
T3a: Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal or renal sinus fat but not beyond Gerota’s fascia
T3b: Tumor grossly extends into the vena cava below the diaphragm
T3c: Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava
T4: Tumor invades beyond Gerota’s fascia, including contiguous extension into the ipsilateral adrenal gland

Notes:
(a) for pT3b tumors, nodules within renal sinus fat usually represent venous involvement (Mod Pathol 2007;20:44)
(b) a breakpoint of 5.5 cm instead of 7 cm for pT1 versus pT2 has been proposed (Cancer 2005;104:2116)

Gross images
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Venous involvement by tumor


Intravenous tumor within renal sinus


Retrograde cortical renal extension

   
Tumor within renal sinus vein

Micro images
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Tumor within sinus vein


Intravenous tumor that itself contains veins

   
Intravenous tumor invading into sinus fat


Smooth muscle actin stain highlights venous wall within tumor


Circumferential perivenous invasion


Regional lymph nodes (N) [not affected by laterality]

General
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NX: Regional lymph nodes cannot be assessed
N0: No regional lymph node metastases
N1: Metastases in regional lymph node(s)
__: No nodes submitted or found

Note: if a lymph node dissection is performed, pathologic examination should include 8+ nodes


Distant metastases (M)

General
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M0: No evidence of metastases based on the surgical specimen and clinical review (in CAP protocol, is called "not applicable", but functions as M0 in anatomic staging below
M1: Distant metastasis


Stage grouping

General
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I: T1 N0 M0
II: T2 N0 M0
III: T1-T2 N1M0 or T3 N0-N1 M0
IV: T4 any N M0 or any T any N M1


Robson classification (used in past)

General
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I: Within renal capsule
II: Infiltrates perinephric fat or adrenal gland but within Gerota's fascia
IIIA: gross renal vein or inferior vena cava involvement (only large veins with smooth muscle in wall, and outside or at edge of main tumor)
IIIB: regional lymph nodes
IIIC: angiolymphatic invasion
IV: invades beyond Gerota's fascia (thin fibrous membrane separating kidney and perinephric adipose tissue from retroperitoneum
IV A: adjacent organs other than ipsilateral adrenal gland
IV B: distant metastases


Templates / Staging diagrams
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Michigan Cancer Consortium template
BC Cancer Agency


Additional references
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J Urol 1969;101:297

End of Kidney tumor > Adult malignancies - Miscellaneous > Staging


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