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).

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.

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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S. Adam Ramin, MD
2080 Century Park East, Suite 1407
Century City

Los Angeles, CA 90067
Phone: 424-260-0262
Fax: (310) 862-0399
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