Staging and grading kidney cancer

Your cancer doctor needs certain information about the cancer to advise you on the best treatment for you. This includes the following:

  • The stage of the cancer, which describes its size and whether it has spread.
  • The grade of the cancer, which gives an idea of how quickly the cancer might grow and spread.

The two main staging systems are the TNM system and the number staging system.

The TNM staging system describes how far the tumour has grown into the kidney and whether it has spread into nearby lymph nodes or other parts of the body.

The number staging system shows how far the cancer has spread on a scale of 1 to 4.

The grade of the cancer describes how quickly the cancer may grow.

Staging and grading

Your cancer doctor needs certain information about the cancer to advise you on the best treatment for you. This includes the following:

  • The stage of the cancer, which describes its size and whether it has spread.
  • The grade of the cancer, which gives an idea of how quickly the cancer might grow and spread.

This information comes from the tests you have had.

Your cancer doctor and specialist nurse will talk to you about this. They will explain how it helps you and your doctor decide on your treatment plan.

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TNM staging

The most commonly used staging system for kidney cancer is the TNM system.

T refers to the tumour size.

N refers to whether lymph nodes are affected.

M refers to whether the cancer has spread to other parts of the body (metastases).

Tumour

  • T1 means the cancer is only inside the kidney and is no bigger than 7cm.
    • T1a – The cancer is 4cm or smaller.
    • T1b – The cancer is bigger than 4cm.
  • T2 means the cancer is only inside the kidney and is bigger than 7cm.
    • T2a – The cancer is between 7cm and 10cm.
    • T2b – The cancer is bigger than 10cm.
  • T3 means the cancer is growing into the fat around the kidney or into a major vein (the renal vein and vena cava) close to the kidney. It is not growing outside the capsule that surrounds the kidney.
    • T3a – The cancer is growing into the fat around the kidney or into the renal vein.
    • T3b – The cancer is growing into the vena cava in the tummy (abdomen).
    • T3c – The cancer is growing into the vena cava in the chest or into the wall of the vena cava.
  • T4 means the cancer has spread through the capsule that surrounds the kidney. It may have grown into the adrenal gland.

Nodes

  • N0 means there are no cancer cells in any lymph nodes.
  • N1 means there are cancer cells in one or more of the lymph nodes.

If the cancer cells have spread to the lymph nodes, doctors will say the nodes are positive.

Metastasis

  • M0 means the cancer has not spread to other parts of the body further away from the kidney.
  • M1 means the cancer has spread to parts of the body further away from the kidney, such as the bones, lungs, liver or brain. If the cancer has spread, it is called secondary or metastatic kidney cancer.


Number staging

This system brings together information from the TNM stages and gives the cancer a number stage. These range from stages 1 to 4.

Stage 1

The cancer is 7cm or smaller and is inside the kidney. It has not spread to the lymph nodes or other organs.

Stage 2

The cancer is bigger than 7cm and is inside the kidney. It has not spread to the lymph nodes or other organs.

Stage 3

The cancer is growing into the fat around the kidney or into one of the major veins close to the kidney (the renal vein or the vena cava). It is not growing through the capsule that surrounds the kidney. It may have spread to the lymph nodes, or it may not.

Stage 4

The cancer has grown through the capsule that surrounds the kidney. It may have spread to the lymph nodes, but not to other parts of the body further away from the kidney.

Or the cancer can be any size and may have grown through the capsule surrounding the kidney, and spread to other parts of the body further away from the kidney.

Having someone to talk to was important for my healing process. I’ve called the Macmillan Support Line many times when feeling depressed, tearful or needing someone just to listen.

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Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.


Grading

A doctor decides the grade of the cancer by looking at the cancer cells under a microscope. The grade gives an idea of how the cancer might grow or spread.

Kidney cancers are usually given a grade from 1 to 4. This is called the Fuhrman system. The lower the number, the lower the grade.

  • Low-grade means the cancer cells are more like normal cells. Grade 1 and 2 cancer cells are slow-growing and less likely to spread.
  • High-grade means the cancer cells are less like normal cells. Grade 3 and 4 cancer cells grow more quickly and are more likely to spread.

When you’re first diagnosed, it’s difficult to see any future. But as things improve, you realise you can still enjoy yourself.

Ian

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