The Role of Staging and Grading...!!!
Staging of a cancer is the process of classifying how far a cancer has spread, while grading determines the characteristics and make up of the cancer’s cells. The two systems play different roles, but both staging and grading are important predictors of the course of the disease and treatment effectiveness. They are useful tools in determining what therapy is appropriate and the chance of treatment success.
How is kidney cancer staged?
There are actually 2 types of staging for kidney cancer. The clinical stage is your doctor's best estimate of the extent of your disease, based on the results of the physical exam, lab tests, and any imaging studies you have had. If you have surgery, your doctors can also determine the pathologic stage, which is based on the same factors as the clinical stage, plus what is found during surgery and examination of the removed tissue. This means that if you have surgery, the stage of your cancer might actually change afterward (if cancer were found to have spread further than was suspected, for example). Pathologic staging is likely to be more accurate than clinical staging, because it allows your doctor to get a firsthand impression of the extent of your disease.
Staging:
Certain imaging tests, including CT and MRI scans, can help determine staging. Blood tests will also be done to evaluate your overall health and to detect whether the cancer has spread to certain organs.
A staging system is a standardized way in which the cancer care team describes the extent of the cancer. The most commonly used staging system was developed by the American Joint Committee on Cancer (AJCC)
American Joint Committee on Cancer (AJCC) TNM Staging System:
The AJCC staging system is based on the evaluation of the tumor size on the kidney (T), the number of lymph nodes (N) and the extent of metastisis (M). Evaluation of the T, N and M components is followed by a stage grouping.
The T component designates the size of the tumor. The numerical value increases with tumor size and extent of invasiveness. The letter T followed by a number from 0 to 3 describes the tumor’s size and spread to nearby tissues. Some of these numbers are further subdivided with letters, such as T1a and T1b. Higher T numbers indicate a larger tumor and/or more extensive spread to tissues near the kidney.
The N component designates the presence or absence of tumor in the regional lymph nodes. In some sites there is an increasing numerical valued based on size, fixation, or capsular invasion. In other sites, numerical value is based on multiple node involvement or number of location and the regional lymph nodes. The letter N followed by a number from 0 to 2 indicates whether the cancer has spread to lymph nodes near the kidney and, if so, how many are affected. Lymph nodes are bean-sized collections of immune system cells that help fight infections and cancers.
The M component identifies the how distant the spread of the cancer has been, including lymph nodes that are not in the region of the original tumor. The letter M followed by a 0 or 1 indicates whether or not the cancer has spread (metastasized) to distant organs such as the lungs or bones, or to lymph nodes that are not near the kidneys.
Detailed Definitions of T, N, and M Categories Primary tumor (T):
Primary tumor (T):
TX: The primary tumor cannot be assessed (information not available).
T0: No evidence of a primary tumor.
T1: The tumor is only in the kidney and is 7 cm (a little less than 3 inches) or less across
T2: The tumor is larger than 7 cm across but is still only in the kidney.
T3: The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland (on top of the kidney) or beyond Gerota's fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue).
T4: The tumor has spread beyond Gerota's fascia (fibrous layer that surrounds the kidney and nearby fatty tissue). The tumor may have grown into the adrenal gland (on top of the kidney).
Regional lymph nodes (N):
NX: Regional (nearby) lymph nodes cannot be assessed (information not available).
N0: No spread to nearby lymph nodes.
N1: Tumor has spread to nearby lymph nodes.
Extent of Metastasis (M):
MX: Presence of distant metastasis cannot be assessed (information not available).
M0: There is no spread to distant lymph nodes or other organs.
M1: Distant metastasis is present; includes spread to distant lymph nodes and/or to other organs. Kidney cancer most often spreads to the lungs, bones, liver, or brain.
How is kidney cancer staged?
There are actually 2 types of staging for kidney cancer. The clinical stage is your doctor's best estimate of the extent of your disease, based on the results of the physical exam, lab tests, and any imaging studies you have had. If you have surgery, your doctors can also determine the pathologic stage, which is based on the same factors as the clinical stage, plus what is found during surgery and examination of the removed tissue. This means that if you have surgery, the stage of your cancer might actually change afterward (if cancer were found to have spread further than was suspected, for example). Pathologic staging is likely to be more accurate than clinical staging, because it allows your doctor to get a firsthand impression of the extent of your disease.
Staging:
Certain imaging tests, including CT and MRI scans, can help determine staging. Blood tests will also be done to evaluate your overall health and to detect whether the cancer has spread to certain organs.
A staging system is a standardized way in which the cancer care team describes the extent of the cancer. The most commonly used staging system was developed by the American Joint Committee on Cancer (AJCC)
American Joint Committee on Cancer (AJCC) TNM Staging System:
The AJCC staging system is based on the evaluation of the tumor size on the kidney (T), the number of lymph nodes (N) and the extent of metastisis (M). Evaluation of the T, N and M components is followed by a stage grouping.
The T component designates the size of the tumor. The numerical value increases with tumor size and extent of invasiveness. The letter T followed by a number from 0 to 3 describes the tumor’s size and spread to nearby tissues. Some of these numbers are further subdivided with letters, such as T1a and T1b. Higher T numbers indicate a larger tumor and/or more extensive spread to tissues near the kidney.
The N component designates the presence or absence of tumor in the regional lymph nodes. In some sites there is an increasing numerical valued based on size, fixation, or capsular invasion. In other sites, numerical value is based on multiple node involvement or number of location and the regional lymph nodes. The letter N followed by a number from 0 to 2 indicates whether the cancer has spread to lymph nodes near the kidney and, if so, how many are affected. Lymph nodes are bean-sized collections of immune system cells that help fight infections and cancers.
The M component identifies the how distant the spread of the cancer has been, including lymph nodes that are not in the region of the original tumor. The letter M followed by a 0 or 1 indicates whether or not the cancer has spread (metastasized) to distant organs such as the lungs or bones, or to lymph nodes that are not near the kidneys.
Detailed Definitions of T, N, and M Categories Primary tumor (T):
Primary tumor (T):
TX: The primary tumor cannot be assessed (information not available).
T0: No evidence of a primary tumor.
T1: The tumor is only in the kidney and is 7 cm (a little less than 3 inches) or less across
- T1a: The tumor is 4 cm (about 1 1/2inches) across or smaller and is only in the kidney.
- T1b: The tumor is larger than 4 cm but not larger than 7 cm across and is only in the kidney.
T2: The tumor is larger than 7 cm across but is still only in the kidney.
- T2a: The tumor is more than 7 cm but not more than 10 cm (about 4 inches) across and is only in the kidney
- T2b: The tumor is more than 10 cm across and is only in the kidney
T3: The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland (on top of the kidney) or beyond Gerota's fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue).
- T3a: The tumor is growing into the main vein leading out of the kidney (renal vein) or into fatty tissue around the kidney
- T3b: The tumor is growing into the part of the large vein leading into the heart (vena cava) that is within the abdomen.
- T3c: The tumor has grown into the part of the vena cava that is within the chest or it is growing into the wall of that blood vessel (the vena cava).
T4: The tumor has spread beyond Gerota's fascia (fibrous layer that surrounds the kidney and nearby fatty tissue). The tumor may have grown into the adrenal gland (on top of the kidney).
Regional lymph nodes (N):
NX: Regional (nearby) lymph nodes cannot be assessed (information not available).
N0: No spread to nearby lymph nodes.
N1: Tumor has spread to nearby lymph nodes.
Extent of Metastasis (M):
MX: Presence of distant metastasis cannot be assessed (information not available).
M0: There is no spread to distant lymph nodes or other organs.
M1: Distant metastasis is present; includes spread to distant lymph nodes and/or to other organs. Kidney cancer most often spreads to the lungs, bones, liver, or brain.
other staging system
University of California Los Angeles (UCLA) Integrated Staging System:
This is a more complex system that came out in 2001. It was meant to improve upon the AJCC staging that was then in place. Along with the stage of the cancer, it takes into account a person's overall health and the Fuhrman grade of the tumor. These factors are combined to divide people into low-, intermediate-, and high-risk groups. Ask your doctor if he or she uses this system and how it might apply to you. In 2002, researchers at UCLA published a study evaluating their system, looking at survival rates of the low-, intermediate- and high-risk groups. For patients with localized kidney cancer (cancer not spread to distant organs) they found 5-year survival rates of 91% for low-risk groups, 80% for intermediate groups, and 55% for high-risk groups.
This is a more complex system that came out in 2001. It was meant to improve upon the AJCC staging that was then in place. Along with the stage of the cancer, it takes into account a person's overall health and the Fuhrman grade of the tumor. These factors are combined to divide people into low-, intermediate-, and high-risk groups. Ask your doctor if he or she uses this system and how it might apply to you. In 2002, researchers at UCLA published a study evaluating their system, looking at survival rates of the low-, intermediate- and high-risk groups. For patients with localized kidney cancer (cancer not spread to distant organs) they found 5-year survival rates of 91% for low-risk groups, 80% for intermediate groups, and 55% for high-risk groups.