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StagingSystemofRenalCellCarcinoma WangJunDepartmentofUrology 1 RenalCellCarcinomaStagingStagingofrenalcellcarcinomaisgenerallycategorizedbytheRobson TNMandclinicalclassificationsystems TheRobsonStagingSystemofRenalCellCarcinomaTheRobsonsystemiscommonlyusedinclinicalpractice Thissystemwasdesignedtocorrelatestageatpresentationwithprognosis TheRobsonstagingsystemisasfollows StageI TumorconfinedwithincapsuleofkidneyStageII TumorinvadingperinephricfatbutstillcontainedwithintheGerotafasciaStageIII Tumorinvadingtherenalveinorinferiorvenacava A orregionallymph nodeinvolvement B orboth C StageIV Tumorinvadingadjacentviscera excludingipsilateraladrenal ordistantmetastases StagingSystemofRenalCellCarcinoma 2 TheTumor Nodes andMetastases TNM ClassificationSystemPrimarytumor T TX PrimarytumorcannotbeassessedT0 NoevidenceofprimarytumorT1 Tumor7cmorsmalleringreatestdimension limitedtothekidneyT2 Tumorlargerthan7cmingreatestdimension limitedtothekidneyT3 TumorextendsintomajorveinsorinvadesadrenalglandorperinephrictissuesbutnotbeyondtheGerotafasciaT3a TumorinvadesadrenalglandorperinephrictissuesbutnotbeyondtheGerotafasciaT3b Tumorgrosslyextendsintotherenalvein s orvenacavabelowthediaphragmT3c Tumorgrosslyextendsintotherenalvein s orvenacavaabovethediaphragmT4 TumorinvadingbeyondtheGerotafascia TNMStagingSystem UICC 2009 3 TheTumor Nodes andMetastases TNM ClassificationSystemRegionallymphnodes N LateralitydoesnotaffecttheNclassificationNX RegionallymphnodescannotbeassessedN0 NoregionallymphnodemetastasisN1 MetastasisinasingleregionallymphnodeN2 Metastasisinmorethan1regionallymphnodeDistantmetastasis M MX DistantmetastasiscannotbeassessedM0 NodistantmetastasisM1 Distantmetastasis TNMStagingSystem UICC 2009 4 Anatomicalstagingclassfication 5 ClinicalstagesstageI T1 N0 M0stageII T2 N0 M0stageIII T1 2 N1 M0orT3a c N0 1 M0stageIV T4 oranyT N2 M0 oranyT anyN M1 Clinicalstagingclassfication 6 T1a left Tumor4cmorlessingreatestdimension limitedtothekidneyT1b right Tumormorethan4cmbutnotmorethan7cm ingreatestdimension limitedtothekidney TNMStagingSystem UICC 2012 7 T2a left Tumormorethan7cmbutlessthanorequalto10cmingreatestdimension limitedtothekidneyT2b right Tumormorethan10cm limitedtothekidney TNMStagingSystem UICC 2012 8 T3a1 upperleft Tumorinvadesperirenaland orrenalsinusfatbutnotbeyondGerota sfasciaT3a2 upperright Tumorgrosslyextendsintotherenalveinoritssegmental musclecontaining branches TNMStagingSystem UICC 2012 9 T3b upperleft TumorgrosslyextendsintothevenacavabelowthediaphragmT3c upperright Tumorgrosslyextendsintothevenacavaabovethediaphragmorinvadesthewallofthevenacava TNMStagingSystem UICC 2012 10 T4a left TumorinvadesbeyondGerota sfasciaT4b right Tumorextendsintotheipsilateraladrenalgland TNMStagingSystem UICC 2012 11 TheTNMclassificationsystemisrecommendedforclinicalandscientificuse However someuncertaintiesremain 1 Thesub classificationofT1tumoursusingacut offof4cmmightnotbeoptimalinNSSforlocalisedcancer 2 ThevalueofsizestratificationofT2tumourshasbeenquestioned 3 Sincethe2002version tumourswithrenalsinusfatinvasionhavebeenclassifiedaspT3a However renalsinusfatinvasionmightcarryaworseprog
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