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.

AJCC 6th Edition—Kidney
Stage Definition
Stage I Primary 7cm or less
Stage II Primary > 7cm
Stage III Perinephric tissue* within Gerota's fascia
One positive regional node
Vena cava
Stage IV Beyond Gerota's fascia > 1 positive regional node Distant metastases
AJCC 6th Edition—Renal Pelvis & Ureter
Stage Definition
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.