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Kidney cancer

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Staging kidney cancer

Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. Extent includes the size of the tumour and where the cancer is in the body. Your healthcare team uses the stage to plan treatment and estimate your prognosis.

The most common staging system for kidney cancer is the TNM system. Each stage is given a number from 1 to 4. Stages 1 to 4 are usually given as the Roman numerals I, II, III and IV. Generally, the higher the number, the more the cancer has spread.

When describing the stage, doctors may use the terms local, regional and distant. Local means that the cancer is only in the kidney and has not spread to other parts of the body. Regional means close to or around the kidney. Distant means in a part of the body farther from the kidney.

TNM descriptions

T describes the size of the primary tumour and if it has grown into tissues around the kidney. T is usually given as a number from 1 to 4. A higher number means that the tumour is larger or has growth farther into nearby tissues or both.

 

N describes the lymph nodes around the kidney. N0 means the cancer hasn’t spread to the lymph nodes. N1, N2 or N3 means cancer has spread to lymph nodes. N1 to N3 can also describe the number of lymph nodes that contain cancer, as well as their size and location.

 

M describes whether or not the cancer has spread, or metastasized, to other parts of the body. M0 means that cancer has not spread to other parts of the body. M1 means that it has spread to other parts of the body.

Stage I

TNMDescription

T1a

N0

M0

The tumour is only in the kidney. It is 4 cm or smaller.

T1b

N0

M0

The tumour is only in the kidney. It is larger than 4 cm but not larger than 7 cm.

Stage II

TNMDescription

T2a

N0

M0

The tumour is only in the kidney. It is larger than 7 cm but not larger than 10 cm.

T2b

N0

M0

The tumour is only in the kidney. It is larger than 10 cm.

Stage III

TNMDescription

T3

N0

M0

The tumour has spread to one of the following:

  • the renal vein and the muscles of the vein
  • the fat around the kidney, but not through the fibrous tissue around the fat (called Gerota’s fascia) or to the adrenal gland on top of the kidney
  • the vena cava (the large vein carrying blood to the heart) above or below the diaphragm (the thin muscle below the lungs and heart that separates the chest cavity from the abdomen)

T1, T2 or T3

N1

M0

One of the following applies:

  • The tumour is no larger than 10 cm and cancer has not spread outside the kidney.
  • The tumour has spread to the renal vein and the muscles of the vein.
  • The tumour has spread into the fat around the kidney, but it has not spread through the fibrous tissue around the fat (called Gerota’s fascia) or to the adrenal gland on top of the kidney.
  • The tumour has spread to the vena cava (the large vein carrying blood to the heart) above or below the diaphragm (the thin muscle below the lungs and heart that separates the chest cavity from the abdomen).

Cancer has spread to 1 lymph node near the kidney.

Stage IV

TNMDescription

T4

any N

M0

The tumour has spread through the fibrous tissue around the kidney fat (called Gerota’s fascia) and spread into the adrenal gland on top of the kidney.

The cancer may or may not have spread to the lymph nodes.

any T

N2

M0

The tumour can be any size and may or may not have grown into any surrounding tissues.

The cancer has spread to more than one lymph node near the kidney.

any T

any N

M1

The tumour can be any size and may or may not have grown into any surrounding tissues.

The cancer may or may not have spread to lymph nodes.

There is a distant metastasis (cancer has spread to other parts of the body, such as the lungs, liver or bone).

Recurrent kidney cancer

Recurrent kidney cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to the primary tumour, it’s called regional recurrence. It can also recur in another part of the body, including the other kidney, which is called a distant metastasis.

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