Renal cell carcinoma classification: Difference between revisions

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|+ '''''TNM Classification System of Renal Cell Carcinoma Staging'''''
|+ '''''TNM Classification System of Renal Cell Carcinoma Staging'''''


| bgcolor="#d9ff54"|'''T.N.M''' || bgcolor="#d9ff54"|'''Stage
| bgcolor="#d9ff54"|'''T.N.M''' || bgcolor="#d9ff54"|'''Stage'''
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|-
| bgcolor="#ececec"|'''Primary Tumor (T)''' || T0: No evidence of primary tumor <br> T1:  Tumor 2.5 cm or less limited to kidney <br> T2: Tumor more than 2.5 cm limited to kidney <br> T3: Tumor extends into major veins or invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia <br> T3a: Tumor invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia <br> T3b: Tumor grossly extends into renal vein(s) or vena cava <br> T4: Tumor grossly extends invades beyond Gerota's fascia
| bgcolor="#ececec"|'''Primary Tumor (T)''' || '''T0''': No evidence of primary tumor <br>'''T1''':  Tumor 2.5 cm or less limited to kidney <br> '''T2''': Tumor more than 2.5 cm limited to kidney <br> '''T3''': Tumor extends into major veins or invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia <br> '''T3a''': Tumor invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia <br> '''T3b''': Tumor grossly extends into renal vein(s) or vena cava <br> '''T4''': Tumor grossly extends invades beyond Gerota's fascia
|-
|-
| bgcolor="#ececec"|'''Regional Lymph Nodes (N)''' || N0: No regional lymph nodes (LN) metastases <br> N1: Metastasis in a single LN 2 cm or less  <br> N2: Metastasis in a single LN  greater than 2 cm, but less than 5 cm, or multiple LN none greater than 5 cm <br> N3: Metastasis in LN greater than 5 cm
| bgcolor="#ececec"|'''Regional Lymph Nodes (N)''' || '''N0''': No regional lymph nodes (LN) metastases <br> '''N1''': Metastasis in a single LN 2 cm or less  <br> '''N2''': Metastasis in a single LN  greater than 2 cm, but less than 5 cm, or multiple LN none greater than 5 cm <br> '''N3''': Metastasis in LN greater than 5 cm
|-
|-
| bgcolor="#ececec"|'''Distant Metastasis (M)''' || M0: No distant metastasis <br> M1: Distant metastasis
| bgcolor="#ececec"|'''Distant Metastasis (M)''' || '''M0''': No distant metastasis <br> '''M1''': Distant metastasis
|}
|}



Revision as of 16:52, 27 December 2013

Renal cell carcinoma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Classification

Sporadic vs. Hereditary

The following tables classify renal cell carcinoma according to histologic appearance and differentiates sporadic from hereditary forms of renal cell carcinoma.

Sporadic Forms

Sporadic Forms of Renal Cell Carcinoma[1]
Histologic Appearance Incidence Gene Frequency
Conventional 75 VHL 60 %
Papillary 12 MET
TFE3
13 %
< 1 %
Chromophobe 4
Oncocytoma 4
Collecting Duct < 1
Unclassified 3 - 5
Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.N Engl J Med. 2005; 353:2477-90

Hereditary Forms

Hereditary Forms of Renal Cell Carcinoma[1]
Syndrome Associated Gene Common Histological Appearance
VHL Disease VHL Conventional
FCRC Chromosome 3p translocation Conventional
Hereditary Paraganglioma SDHB Conventional
HPRC MET Papillary
HLRCC FH Papillary
Birt-Hogg-Dube Syndrome BHD Chromophobe / Oncocytoma
Adapted from Cohen HT, McGovern FJ. Renal-cell carcinoma.N Engl J Med. 2005; 353:2477-90

Staging

Clear cell renal carcinomas can be classified according to staging or anatomic spread of the disease. Two commonly implemented systems are the Modified Robson's System (1969) and the TNM (Tumor - Nodes - Metastasis) System:

Robson's System

The Modified Robson's staging system has been proposed in 1969. It emphasizes the anatomic distribution of the tumor and proximity to important vasculature and lymph nodes with prognostic implications, reporting a 52% 5-year survival and a 66% 5-year survival in patients with localized tumor.[2]

Robson's Classification System of Renal Cell Carcinoma Staging[2]
Stage Definition
Stage I Tumor confined within parenchyma
Stage II Tumor involves perinephric fat, but still confined within Gerota's fascia
Stage III A) Tumor involves main renal vein or vena cava
B) Tumor involves regional lymph nodes
C) Tumor involves both local vessels and lymph nodes
Stage IV A) Tumor involves adjacent organs other than adrenal gland
B) Distant metastasis
Adapted from Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. 1969; 101(3):297-301.

TNM System

The TNM classification system for staging of clear cell renal carcinoma is commonly used.

TNM Classification System of Renal Cell Carcinoma Staging
T.N.M Stage
Primary Tumor (T) T0: No evidence of primary tumor
T1: Tumor 2.5 cm or less limited to kidney
T2: Tumor more than 2.5 cm limited to kidney
T3: Tumor extends into major veins or invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia
T3a: Tumor invades adrenal gland or perinephric tissues, but not beyond Gerota's fascia
T3b: Tumor grossly extends into renal vein(s) or vena cava
T4: Tumor grossly extends invades beyond Gerota's fascia
Regional Lymph Nodes (N) N0: No regional lymph nodes (LN) metastases
N1: Metastasis in a single LN 2 cm or less
N2: Metastasis in a single LN greater than 2 cm, but less than 5 cm, or multiple LN none greater than 5 cm
N3: Metastasis in LN greater than 5 cm
Distant Metastasis (M) M0: No distant metastasis
M1: Distant metastasis

References

  1. 1.0 1.1 Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.
  2. 2.0 2.1 Robson CJ, Churchill BM, Anderson W (1969). "The results of radical nephrectomy for renal cell carcinoma". J Urol. 101 (3): 297–301. PMID 5765875.


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