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Adrenal gland
cancer

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Stages of adrenal gland cancer

Staging is a way of describing or classifying a cancer based on the extent of adrenal gland cancer in the body.

There is no standard staging system for pheochromocytoma. People with pheochromocytoma are divided into categories based on the presence of localized, regional and metastatic disease.

  • Localized refers to apparently benign tumours that are confined to the adrenal gland.
  • Regional refers to tumours that have extended into nearby tissues, lymph nodes or organs.
  • Metastatic refers to tumours that have spread to distant sites, such as the bones, lungs or liver.

The most common staging system for adrenocortical carcinoma is the TNM system. The International Union Against Cancer (UICC) uses the TNM system to describe the extent of many solid tumour cancers.

TNM

TNM stands for tumour, nodes, metastasis. TNM staging describes:

  • the size of the primary tumour
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another part of the body

Primary tumour (T)

TX

Primary tumour cannot be assessed

T0

No evidence of primary tumour

T1

Tumour is 5 cm or less is size and has not grown into tissues outside the adrenal gland (extra-adrenal invasion).

T2

Tumour is larger than 5 cm in size and there is no extra-adrenal invasion.

T3

Tumour is any size and has grown into the fat that surrounds the adrenal gland, but not into nearby (adjacent) organs.

T4

Tumour is any size and has grown into nearby organs.

Note: Nearby organs include kidney, diaphragm, pancreas, spleen, liver and main blood vessels.

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Stage grouping for adrenocortical carcinoma

The UICC further groups the TNM data into the stages listed in the table below.

UICC staging – adrenocortical carcinoma
UICC stageTNMExplanation

stage I

T1

N0

M0

The tumour is 5 cm or smaller and has not grown beyond the adrenal gland.

There is no spread to lymph nodes or other parts of the body.

stage II

T2

N0

M0

The tumour is larger than 5 cm, but has not grown beyond the adrenal gland.

There is no spread to lymph nodes or other parts of the body.

stage III

T1 or T2

N1

M0

The tumour is any size, but has not grown beyond the adrenal gland.

There is spread to nearby lymph nodes, but not to other parts of the body.

T3

N0

M0

The tumour has grown into the fat outside the adrenal gland.

There is no spread to nearby lymph nodes or to other parts of the body.

stage IV

T3

N1

M0

The tumour has grown into the fat outside of the adrenal gland.

There is spread to nearby lymph nodes, but not to other parts of the body.

T4

any N

M0

The tumour has grown into nearby organs.

There may or may not be spread to nearby lymph nodes, but not to other parts of the body.

any T

any N

M1

The tumour is any size, with or without spread to the nearby tissues and organs.

There may or may not be spread to nearby lymph nodes.

There is spread to other parts of the body (distant sites).

Recurrent adrenal gland cancer

Recurrent adrenal gland cancer means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic adrenal gland cancer).

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