Stages of Kidney Cancer

Although grading and the identification of cancer cell types help determine a patient's prognosis, most doctors believe that the most important factor in predicting prognosis, as well as the treatment options, is the "stage" of the cancer.

Staging is the process of gathering information from physical examinations and diagnostic tests to determine the size and location of the tumor and how widespread a cancer is. Diagnostic tests include imaging studies such as CT scans and MRIs.

Staging Factors that Influence a Patient's Prognosis are:

• Spread to tissues surrounding the kidney
• Spread to contiguous organs (organs next to the kidney)
• Spread to nearby lymph nodes (the small, bean-shaped structures found throughout the body that produce and store infection-fighting cells)
• Spread to other organs like lung, bone, liver (distant metastasis)

The treatment and prognosis for renal cell carcinoma will depend significantly on its stage. There are two common staging systems for RCC, the TNM System and the New University of California Los Angeles Integrated Staging System (UISS). The Fuhrman Grading System is a system used to describe how kidney tumors appear under the microscope.

TNM Staging System
The most commonly used staging system is that of the American Joint Committee on Cancer (AJCC), also known as the TNM Staging System. The TNM (tumor-node-metastasis) system uses stages generally similar to those of the Robson system and is becoming more widely accepted because it provides a more detailed description of the tumor(s).

• The letter T followed by a number from 0 to 4 describes the tumor's size and spread to nearby tissues. Some of these numbers are further subdivided with letters, such as T1a and T1b. Higher T numbers indicate a larger tumor and/or more extensive spread to tissues near the kidney.
• The letter N followed by a number from 0 to 2 indicates whether the cancer has spread to lymph nodes near the kidney and, if so, how many are affected. Lymph nodes are bean-sized collections of immune system cells that help the body to fight infections and cancers.
• The letter M followed by a 0 or 1 indicates whether or not the cancer has spread (metastasized) to other organs such as the lungs or bones, or to lymph nodes that are not near to the kidneys.

"T" STAGE

Primary Tumor Stage (T Stage)	Graphic Representation	Description
T1 < 4 cm: T 1a 4 - < 7 cm: T 1b		Tumor is confined to the kidney (no penetration through the capsule) and is no greater than 7 cm in dimension.
T2		Tumor is confined to the kidney (no penetration through the capsule) and is greater than 7 cm in dimension
T3a		Tumor penetrates through the kidney capsule into the surrounding fat or the adrenal gland, but not through Gerota's fascia.
T3b or T3c		Tumor extends into the renal vein or into the vena cava.  (T3b indicates that the tumor thrombus does not extend above the level of the diaphragm. T3c indicates that the tumor thrombus extends above the level of the diaphragm.)
T4		Tumor penetrates through Gerota's fascia.

"N" STAGE

Regional Lymph Nodes (N stage)	Description
N0	No cancer in the lymph nodes
N1	Cancer in a single lymph node
N2	Cancer in more than one lymph node

"M" STAGE

Distant Metastasis (M Stage)	Description
M0	No metastasis
M1	Distant metastasis present

The New UCLA Integrated Staging System (UISS)

The New UCLA Integrated Staging System (UISS) is a more complex but probably more accurate system that incorporates the TNM staging systems, a person's overall health and the Fuhrman grade of the tumor.

In the UISS system: Patients without any tumor spread are divided into three groups: low risk, intermediate risk and high risk.

• The Low Risk group is considered Stage I; are in excellent health other than the cancer and have a low Fuhrman grade tumor.
• The Intermediate Risk group is all others, without any spread.
• The High Risk group is either Stage III (but without lymph node spread), in poor health and have a high Fuhrman grade score; or Stage IV (without any spread, T4, N0, M0).

The five-year cancer-specific survival (only deaths from cancer) for the low risk group is 91%, for the intermediate risk group is 80%, and for the high risk group is 55%.

Patients with tumor spread, to lymph nodes or distance sites such as bone, lung or liver, are also divided into these three groups. Low risk patients have a tumor that is T1-3, N1, M0. High risk patients have a T4 tumor, poor health and high Fuhrman grade or distant spread. Intermediate grades are all others. The five-year cancer-specific survival is lower in these people whose tumors have spread: for the low risk group it is 32%, for the intermediate risk group 20% and for the high risk group 0%.

 



 

Fuhrman Grading Scale for Kidney Cancer

Another important factor used by doctors in assessing renal cell carcinoma is its Fuhrman grade (named after the pathologist who developed the system). This refers to how closely the cancer cells look like normal kidney cells under a microscope. The Fuhrman grading system ranks tumor cells on a scale of 1 through 4. Grade 1 tumor cells don't look very different from normal kidney cells. Grade 1 cancers typically grow and spread slowly and most often have a good prognosis. On the other hand, Grade 4 tumor cells look quite different from normal kidney cells and have a worse prognosis.