Diagnosis and Staging

Disease Staging

The information within this section has been reprinted with permission from eMedicine.com, 2010. Available at:  http:/anti-infectives/Paris-Event/Live-Webcast.cfmemedicine.medscape.com/article/281340-overview 

  • The Robson modification of the Flocks and Kadesky system is uncomplicated and is used commonly in clinical practice. This system was designed to correlate stage at presentation with prognosis. The Robson staging system is as follows: 
    • Stage I - Tumor confined within capsule of kidney
    • Stage II - Tumor invading perinephric fat but still contained within the Gerota fascia
    • Stage III - Tumor invading the renal vein or inferior vena cava (A), or regional lymph-node involvement (B), or both (C)
    • Stage IV - Tumor invading adjacent viscera (excluding ipsilateral adrenal) or distant metastases
  • The tumor, nodes, and metastases (TNM) classification is endorsed by the American Joint Committee on Cancer (AJCC). The major advantage of the TNM system is that it clearly differentiates individuals with tumor thrombi from those with local nodal disease. In the Robson system, stage III disease includes both inferior vena caval involvement (stage IIIA) and local lymph node metastases (stage IIIB). Although patients with Robson stage IIIB renal carcinoma have greatly decreased survival rates, the prognosis for patients with stage Robson IIIA renal carcinoma is not markedly different from that for patients with Robson stage I or II renal carcinoma. The TNM classification system is as follows:
    • Primary tumor (T) 
      • TX - Primary tumor cannot be assessed
      • T0 - No evidence of primary tumor
      • T0 - No evidence of primary tumor
      • T1 - Tumor 7 cm or smaller in greatest dimension, limited to the kidney
      • T2 - Tumor larger than 7 cm in greatest dimension, limited to the kidney
      • T3 - Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond the Gerota fascia
      • T3a - Tumor invades adrenal gland or perinephric tissues but not beyond the Gerota fascia
      • T3b - Tumor grossly extends into the renal vein(s) or vena cava below the diaphragm
      • T3c - Tumor grossly extends into the renal vein(s) or vena cava above the diaphragm
      • T4 - Tumor invading beyond the Gerota fascia
    • Regional lymph nodes (N) - Laterality does not affect the N classification
      • NX - Regional lymph nodes cannot be assessed
      • N0 - No regional lymph node metastasis
      • N1 - Metastasis in a single regional lymph node
      • N2 - Metastasis in more than 1 regional lymph node
    • Distant metastasis (M)
      • MX - Distant metastasis cannot be assessed
      • M0 - No distant metastasis
      • M1 - Distant metastasis
    • AJCC stages
      • AJCC stage I - T1, N0, M0
      • AJCC stage II - T2, N0, M0
      • AJCC stage III - T1-2, N1, M0 or T3a-c, N0-1, M0
      • AJCC stage IV - T4; or any T, N2, M0; or any T, any N, M1
    • The division of patients with renal cell carcinoma into low-, intermediate-, and high-risk groups with or without metastases may be useful in choosing appropriate therapy for them.1,2

References:
1. Jonasch et al. Renal Cell Carcinoma. In: Kantarjian HM, Wolff RA, Koller CA, eds. MD Anderson Manual of Medical Oncology. New York, NY: McGraw-Hill; 2006.
2.  Zisman A, Pantuck AJ, Wieder J, Chao DH, Dorey F, Said JW. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol. Dec 1 2002;20(23):4559-66. [Medline].