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Staging

Updated 28 June 2007

Classification Criteria

TPRIMARY TUMOUR
TXPrimary tumour cannot be assessed
T0No evidence of primary tumour
T1aTumour 4 cm or less in greatest dimension, limited to the kidney
T1bTumour greater than 4 cm, but not more than 7 cm, in greatest dimension, limited to the kidney
T2Tumour more than 7.0 cm in greatest dimension, limited to the kidney
T3aTumour invades adrenal gland or perinephric tissues but not beyond Gerota fascia
T3bTumour grossly extends into renal vein(s) or vena cava below diaphragm
T3cTumour grossly extends into vena cava above diaphragm
T4Tumour invades beyond Gerota fascia
  
NREGIONAL LYMPH NODES *
 The regional lymph nodes are the hilar, abdominal para-aortic, and para caval nodes. Laterality does not affect the N categories
NXRegional lymph nodes cannot be assessed
N0No regional lymph node metastasis
N1Metastasis in a single regional lymph node
N2Metastasis in more than one regional lymph node
  
*Laterality does not affect the N classification
  
NOTEIf a lymph node dissection is performed, then pathologic evaluation would ordinarily include at least eight nodes
  
MDISTANT METASTASIS
 Including extraregional lymph nodes
MXDistant metastasis cannot be assessed
M0No distant metastasis
M1Distant metastasis
  
VINVASION OF VEINS (TNM Atlas UICC 1985)
VXVenous invasion cannot be assessed
V0Veins do not contain tumour
V1Renal vein contains tumour
V2Vena cava contains tumour
  
GRADE(Fuhrman Nuclear Grade – ref: Am J Surg Pathol 6:655-663, 1982)
1Tumour composed of cells with small (approx. 10µ) round uniform nuclei with inconspicuous or absent nucleoli
2Tumour composed of cells with larger (approx. 15µ) nuclei which exhibited irregularities in outline and nucleoli when examined under high (400x)power
3Tumour composed of cells with large nuclei (approx.20µ) with an obviously irregular outline and prominent large nuclei even at low (100x) power
4Tumour composed of features similar to grade 3 with the addition of bizarre, often multilobed nuclei and heavy chromatin clumps. These tumours often had areas of spindled-shaped cells resembling sarcomas
XUnknown/not assessed

Staging Diagram

Kidney staging diagr​am

Investigations for Staging

2002 TNM staging system recommended (see above).When surgery is considered, it is assumed that the patient will have been fully investigated to rule out metastatic disease.

The investigations should include:

  1. History and physical examination
  2. CBC, liver function tests, BUN, creatinine, calcium
  3. Chest X-ray
  4. Intravenous pyelogram
  5. CT scan abdomen
  6. Bone scan
  7. CT brain (if suspect symptoms present)
  8. Angiograms (for selected cases)

SOURCE: Staging ( )
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