Criteria for TNM Clinical Staging:
Physical examination and history, histologic confirmation of tumor, urinary endoscopy, urinary cytology, pyelography, imaging (radiographic and computer assisted), and other evaluations to determine metastatic involvement; laparotomy may be included in clinical staging.
Criteria for TNM Pathologic Staging:
Radical nephrectomy, including removal of the primary tumor, entire kidney, adrenal gland, perinephric fat, Gerota's fascia, renal vein and lymph node resection are required for pathologic staging. For renal pelvis and ureteral cancers, the ureter and a portion of the bladder (bladder cuff) should also be resected.
|Stage I||Primary 7cm or less|
|Stage II||Primary > 7cm|
|Stage III||Perinephric tissue* within Gerota's fascia
One positive regional node
|Stage IV||Beyond Gerota's fascia > 1 positive regional node Distant metastases|
|Stage 0a||Noninvasive papillary carcinoma|
|Stage 0is||Carcinoma in situ|
|Stage I||Subepithelial connective tissue invaded|
|Stage II||Muscularis invaded|
|Stage III||Beyond muscularis into peripelvic/periureteric fat or renal parenchyma|
|Stage IV||Adjacent organs, through kidney into perihephric fat, any positive node(s), distant metastasis|
* adrenal gland, fat, renal veins
Collaborative Stage Elements
For more details on Collaborative Stage, see the Intro to Collaborative Staging module.