How is kidney cancer staged?

by Specialist

Clinicians perform clinical staging of kidney cancer based on the results of imaging or nuclear examinations (CT scan, x-ray chest radiograph, ultrasonography, bone scan, MRI, etc.) to initially determine the extent of the lesion and whether the tumor is confined to the kidney or has disseminated outside the kidney. The pathologists derived the pathological stage of kidney cancer after pathological examination of the resected kidney, tumor, and surrounding fatty lymph connective tissue.

Currently, kidney cancer is staged using a combination of the 2010 American Joint Committee on Cancer (AJCC) TNM staging and AJCC staging.

2010 AJCC Kidney Cancer Staging Portfolio

Staging Tumor status
Stage I T1 N0 M0
II period T2 N0 M0
Phase III

T3

N0 or N1

M0
T1,T2 N1 M0
Phase IV

T4

Any N

M0
Any T Any N M1

For example, if a patient with kidney cancer has a tumor ≤4 cm, confined to the kidney (T1a), with no lymph node metastases (N0) and no distant metastases (M0), then the patient is staged as T1aN0M0, or stage I;

If the patient’s tumor has developed regional lymph node metastases (N1) and pulmonary metastases (M1), then the patient is stage IV, regardless of tumor size.

Kidney cancer staging helps to understand the extent of the disease (tumor size and spread), determine prognosis, and decide on treatment options, which vary considerably by stage.

  • For stage I and II patients, because the lesion is confined to the kidney, it can also be called early stage renal cancer, and depending on the size and location of the tumor, early nephrectomy can be pursued.

  • For stage III patients whose tumors have not yet metastasized distantly but have locally invaded the surrounding renal tissues, surgery may be temporarily unavailable, and further surgery may be pursued with appropriate drugs and other treatments to regress the tumor.

  • For stage IV patients who have developed distant metastases, a combination of therapies including surgery, molecular targeted therapy, and immunotherapy can be aggressively pursued.