Staging of Kidney Tumors

Classifying Your Cancer

Pathology tests help to determine the cancer stage and grade — classifications that are essential to choosing the most effective cancer treatment and predicting how the disease will progress.

Staging is the process by which your cancer specialists determine how to treat your cancer and how far your cancer has spread. It takes into account the primary (original) tumor size, number of tumors and whether it has metastasized, or spread to the lymph nodes or distant parts of the body. Staging is based on the pathology report, physical exam and imaging tests. Generally, a lower stage indicates a better prognosis (i.e., the likely outcome or course of a disease; the chance of a full recovery or recurrence).

The American Joint Committee on Cancer (AJCC) uses the TNM classification to define the stages of kidney cancer:

T is for Tumor. The number after the T indicates the size of the tumor and how far it has invaded. The larger the number, the bigger and/or more invasive the cancer. The range is from Tx (cannot be assessed) to T4 (tumor has invaded other organs).

  • TX means the primary tumor cannot be assessed.
  • T0 means there is no evidence of primary tumor.
  • T1 means the tumor is 7 cm or less and is limited to the kidney.
  • T1a means the tumor more than 4 cm or less in greatest dimension, limited to the kidney.
  • T1b means the tumor is more than 4 cm but not more than 7 cm and is limited to the kidney.
  • T2 means the tumor is more than 7 cm and is limited to the kidney.
    • T2a means the tumor is more than 7 cm but not more than 10 cm and is limited to the kidney.
    • T2b means the tumor is more than 10 cm and is limited to the kidney.
  • T3 means the tumor extends into major veins, the adrenal gland, or the tissue around the nephrons, but does not go beyond Gerota’s fascia.
  • T3a means the tumor has invaded the adrenal gland or the nearby fatty tissue but does not go beyond Gerota’s fascia.
  • T3b means the tumor has deeply invaded the renal vein or one of its branches, or has invaded the vena cava (a major vein that brings blood to the heart so it can be pumped to the lungs to get oxygen) below your diaphragm.
  • T3c means the tumor extends into the vena cava above your diaphragm or it has invaded the wall of the vena cava.
  • T4 means the tumor invasion has gone beyond Gerota’s fascia.

N is for Nodes. The number after the N indicates whether the cancer has spread to the lymph nodes and to what extent. The range is from Nx (cannot be assessed) to N1 (metastasis to regional lymph nodes).

  • NX means the regional lymph nodes cannot be assessed.
  • N0 means there is no cancer in the lymph nodes in the region of the cancer.
  • N1 means there has been metastasis to regional lymph nodes.

M is for Metastasis. The number after the M indicates whether the cancer has spread to distant areas of the body. M0 means no distant metastasis and M1 means cancer has spread to at least one distant site.

  • M0 means there is no distant metastasis.
  • M1 means the cancer has metastasized to at least one site distant from the kidney.

Once these categories have been assigned, they are combined to determine an overall stage of disease: I, II, III or IV. In most cases, the lower the number, the better the prognosis.

Stage Grouping

Stage Groups

Tumor Nodes Metastases
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T1 N1 M0
  T2 N1 M0
  T3 N0 M0
  T3 N1 M0
Stage IV T4 Any N M0
  Any T Any N M1