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Kidney Cancer Staging and Grading

The "staging" process for any type of cancer is designed to determine how far the cancer has spread (metastasized), because this information helps determine the best treatment options as well as overall prognosis.

Stage I:

The tumor is 7 cm across or smaller and is only in the kidney (T1). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage II:

The tumor is larger than 7 cm across but is still only in the kidney (T2). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage III: Either of the following:

The tumor is growing into a major vein (like the renal vein or the vena cava) or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota's fascia (T3). There is no spread to lymph nodes (N0) or distant organs (M0).

The main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota's fascia.  The cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0).

Stage IV: Either of the following:

The main tumor is growing beyond Gerota's fascia and may be growing into the adrenal gland on top of the kidney (T4). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant lymph nodes or other organs (M0).

The main tumor can be any size and may have grown outside the kidney (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes and/or other organs (M1).

TNM Staging
A more detailed form of staging is TNM kidney cancer staging.  The TNM staging system describes the extent of the primary tumor (T), the absence or presence of metastasis to nearby lymph nodes (N) and the absence or presence of distant metastasis (M).

Stage

Description

T1

Tumor is only in the kidney and is 7cm or less across

T1a

Tumor is 4cm across or smaller and is only in the kidney

T1b

Tumor is larger than 4 cm across but not larger than 7 cm across and is only in the kidney

T2

Tumor is larger than 7 cm across and only in the kidney

T2a

Tumor is more than 7 cm but not more than 10 cm across and is only in the kidney

T2b

Tumor is more than 10 cm across and is only in the kidney

T3

Tumor is growing into a major vein or into tissue around the kidney, but is not growing into the adrenal gland (on top of the kidney) or beyond Gerota's fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue)

T3a

Tumor is growing into main vein leading out of the kidney (renal vein) or into fatty tissue around the kidney

T3b

Tumor is growing into the part of the large vein leading into the heart (vena cava) that is within the abdomen

T3c

Tumor has grown into the part of the vena cava that is within the chest wall or is growing into the wall of that blood vessel (the vena cava itself)

T4

Tumor has spread beyond Gerota's fascia, may have grown into adrenal gland or extends to adjacent organs

Node (N)

Regional (pelvic) lymph nodes

N0

No lymph node (LN) metastasis

N1

Tumor has spread to nearby lymph nodes

Metastasis (M)

Tumor spread to distant sites

M0

No distant metastasis to lymph nodes or other organs

M1

Distant metastasis present; includes spread to distant lymph nodes and/or other organs

M1a

Distant (non-regional) LN involvement

M1b

Metastasis to the bones

M1c

Metastasis to other distant organs (lung, brain)

Relationship between TNM Prostate Cancer Staging and Stage
Categories I to IV:

Stage

T

N

M

I T1 N0 M0
II T2 N0 M0
III T3 N0 M0
IV T4

N0 — N3

M0 — M1

Any T

N0 — N3

M1

Survival & Stage

For comparison purposes, the below statistics from the National Cancer Institute are based on "relative survival." This means they are a comparison of the general population to kidney cancer patients at various stages of disease.  The overall 5-year relative survival for 2002-2008 from 18 SEER geographic areas was 70.6%. Five-year relative survival by race and sex was: 70.8% for white men; 71.0% for white women; 68.1% for black men; 68.1% for black women.

Stage Distribution and 5-year Relative Survival by Stage at Diagnosis for
2002-2008, All Races, Both Sexes

Stage at Diagnosis

Stage
Distribution (%)

5-year
Relative Survival (%)

Localized (confined to primary site)

62 91.1

Regional (spread to regional lymph nodes)

17 63.7

Distant (cancer has metastasized)

17 11.6

Unknown (unstaged)

4 34.3

Kidney Cancer Grading

The process for determining the characteristics of a cancer's cells is called Fuhrman grading.  The Fuhrman grade given to an individual's kidney cancer diagnosis is based on an examination and comparison of how closely the cancer cell's nucleus (part of a cell in which DNA is stored) looks like a normal kidney cell's nucleus.

Kidney cancers are usually given a Fuhrman grade on a scale of 1- 4.  Grade 1 kidney cancers look very much like normal kidney cells.  These cancers are usually slow growing and are slow to spread to other parts of the body (metastasize). They tend to have a good outlook (prognosis). Grade 4 kidney cancer, on the upper end of the Fuhrman scale, looks quite different from normal kidney cells and has a worse prognosis.  Generally, the higher the Fuhrman grade the worse the prognosis.

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