Kidney Cancer Basics: Stages


With the staging of Kidney Cancer, doctors have knowledge about the extent of the disease, while at the same time they take the first step to create the treatment plan.
Stages of Kidney Cancer based on the results of some protocols. That is means, patients diagnosed with kidney cancer should undergo several certain tests to determine the treatment and the seriousness of the disease.

Staging Tests

Doctors use a number of diagnostic tests to determine how much cancer has grown and how much it has spread to your body.
These tests are named as staging tests.
Some of these staging tests are recommended for all kidney cancer patients, as soon as they have the diagnosis.
On the other hand, other staging tests are only recommended if the patient has sign and symptoms of kidney cancer spread, or if there is a clinically suspicious situation.

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a. CT scan

CT scan allows to display the inside of the body with using the X-rays. Thus, it can be seen that if kidney cancer is grown into the adrenal glands which are located just above the kidneys or to the lymph nodes that near the kidney.

Also, a CT scan of the chest may be used for the screening of lungs to check if cancer has metastasized. Because, lungs are the one of the most common distant metastasize site for kidney cancer. Besides, if symptoms of brain metastasize present, a CT scan of brain may also be used.

b. MRI scan

MRI scan is an imaging technique that allows visualizing of the inside of the body using radio waves and magnetic field. In an abdominal MRI scan, the vessels near to the kidney can be viewed. Thus, spreading of the cancer to the major vessels such as Aorta or Vena Cava can be checked.

MRI scan provides clearer and better-quality images than CT scan. It can also be used for brain imaging, such as CT scan.

For more information about the tests which are done during diagnosis of kidney cancer, you can read:
Kidney Cancer Basics: Diagnosis


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TNM Scoring

The TNM scoring is a scoring developed by the American Joint Committee on Cancer (AJCC) and used for staging of kidney cancer.

In this system, letters such as T, N and M describes the different areas of Kidney Cancer.

Your doctor will perform your cancer scoring according to the tests performed.

a. T (Tumor)

This score describes the growth of the primary tumor. The T score shows how much the primary tumor has grown, and also if it has grown toward the surrounding tissues.

  • Tx: Primary tumor can not be assesed.
  • T0: No signs of a primary tumor
  • T1: Tumors are only in the kidney and are not
    • T1a: Tumors are ≤4 cm
    • T1b: Tumors are ≥4 cm but ≤7 cm
  • T2: Only in the kidney and are larger
    • T2a: Tumors are ≥7 cm but ≤10 cm
    • T2b: Tumors are ≥10 cm
  • T3: Tumor extended beyond the kidney.
    • T3a: Tumors have grown into the inside/outside renal fat, or into the renal vein, or muscle of the vein
    • T3b: Tumor have grown into Vena Cava below the diaphragm
    • T3c: Tumors have grown into Vena Cava, above the diaphragm.
  • T4: Tumors have grow beyond the Gerota’s fascia, and may extend to adrenal gland.

For more information about Gerota’s fascia of the kidney, you can read:
Kidney Cancer Basics: What is the Kidney?


b. N (Nodes)

The N score shows the how much the cancer is spread to the lymph nodes.

  • Nx: Nearby lymph nodes cannot be assessed.
  • N0: The cancer has not spread to nearby lymph nodes.
  • N1: The cancer has spread to nearby lymph nodes

c. M (Metastasis)

The M score shows if cancer has spread to the distant sites, such as lungs, liver, brain, bones and distant lymph nodes.

  • M0: The cancer has not spread to distant sites.
  • M1: The cancer has spread to distant sites.

Stages of Kidney Cancer

Kidney cancer stages are divided from I to IV with Roman numerals.
As the stage increases, the prognosis of cancer worsens and its treatment becomes difficult.
In general, there are better outcomes in early stages of kidney cancers.
The cancers of the same stage generally follow the same clinical course and are therefore they are treated in the same way.

There is one detail that is important here.
While the stages of kidney cancers were defined, data were collected from kidney cancer patients all over the world. From this data, according to stages, the mean prognoses were calculated.
However, the progression of cancer in each person may not be the same. In some patients, good clinical outcome may be seen, while in some patients this may be the opposite.

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a. Stage I Kidney Cancer

T1, N0, M0: This means that, tumor is only limited to the kidney and its diameter is not larger than the 7 cm (T1). Cancer has not spread to any lymph nodes (N0). Finally, cancer has not spread to distant sites (M0).

b. Stage II Kidney Cancer

T2, N0, M0: This means that, again, tumor is only limited to kidney, but this time it’s diameter is larger than 7 cm (T2). Still cancer has not spread to any lymph nodes (N0) and there is no distant or nearby metastasizes (M0).

c. Stage III Kidney Cancer

T3, N1/N0, M0: Here, tumor is extending beyond the nearby tissues of the kidney (T3). The cancer may or may not be spread to nearby lymph nodes (N0/N1). Again cancer has not spread to distant sites (M0).

T1/T2, N1, M0: This time tumor is limited to kidney but its diameter may or may not be larger than 7 cm (T1/T2). But the cancer has spread to nearby lymph nodes (N1). Still, there is no distant or nearby metastasizes.

d. Stage IV Kidney Cancer

T4, N1/N0, M1: In here, tumor has grown beyond the Gerota’s fascia and even may be to adrenal gland (T4). Cancer may or may not be spread to the nearby lymph nodes (N0/N1) but there is distant metastasizes (M1).

T1-T4, N1/N0, M1: Tumor can be in any size (T1-4), there may or may not be spreading to lymph nodes (N1/N0) but certainly cancer has spread to distant sites in body.

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