Renal Cell Carcinoma Staging

Updated: Mar 31, 2022
  • Author: Kush Sachdeva, MD; Chief Editor: E Jason Abel, MD  more...
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TNM Classification for Renal Cell Carcinoma

The tumor-node-metastasis (TNM) classification for renal cell carcinoma is provided below. [1, 2]

Table 1. TNM Classification for Renal Cell Carcinoma (Open Table in a new window)

Primary tumors (T)

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

T1

Tumor ≤7 cm in greatest dimension, limited to the kidney

T1a

Tumor ≤4 cm in greatest dimension, limited to the kidney

T1b

Tumor >4 cm but ≤7 cm in greatest dimension, limited to the kidney

T2

Tumor >7 cm in greatest dimension, limited to the kidney

T2a

Tumor >7 cm but ≤10 cm in greatest dimension, limited to the kidney

T2b

Tumor >10 cm, limited to the kidney

T3

Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond the Gerota fascia

T3a

Tumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond the Gerota fascia

T3b

Tumor grossly extends into the vena cava below the diaphragm

T3c

Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava

T4

Tumor invades beyond the Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)

Regional lymph node (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in regional lymph node(s)

Distant metastasis (M)

M0

No distant metastasis

M1

Distant metastasis

Table 2. Anatomic stage/prognostic groups (Open Table in a new window)

Stage

T

N

M

I

T1

N0

M0

II

T2

N0

M0

III

T1-2

N1

M0

T3

NX, N0, or N1

M0

IV

T4

Any N

M0

Any T

Any N

M1

Table 3. Histologic Grade (Open Table in a new window)

Grade

X

Grade cannot be assessed

1

Nucleoli absent or inconspicuous and basophilic at 400x magnification

2

Nucleoli conspicuous and eosinophilic at 400x magnification, visible but not prominent at 100x magnification

3

Nucleoli conspicuous and eosinophilic at 100x magnification

4

Marked nuclear pleomorphism and/or multinucleate giant cells and/or rhabdoid and/or sarcomatoid differentiation

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