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Tuesday, 16 May 2006 |
- Fuhrman grading system
- Grade is an important variable
- Fuhrman system has issues with interobserver variability
- UICC-AJCC system is generally accepted Table 1
- Currently T1 lesion is 7 cm or less in size, yet 4.0 cm
- Associated with very low recurrence rate
- T1a category of <4.0 cm suggested
Table 1: Tumor Node Metastasis (TNM) Staging System for Renal Tumors
American Joint Commission for Cancer (AJCC) 1997
| Primary Tumor (T) |
| TX |
Primary tumor cannot be assessed |
| TO |
No evidence of primary tumor |
| T1 |
Tumor 7 cm or less in dimension limited to the kidney |
| T2 |
Tumor more than 7 cm in dimension limited to the kidney |
| T3a |
Tumor invades adrenal gland or perinephric tissues but not Gerota's fascia |
| T3b |
Tumor grossly extends into renal vein or vena cava below diaphragm |
| T3c |
Tumor grossly extends into vena cava above diaphragm |
| Regional Lymph Nodes (N) |
| NX |
Regional lymph nodes cannot be assessed |
| NO |
No regional lymph node metastasis |
| N1 |
Metastasis in a single regional lymph node or nodes |
| N2 |
Metastasis in more than one regional lymph node |
| Distant Metastasis (M) |
| MX |
Distant metastasis cannot be assessed |
| MO |
No distant metastasis |
| M1 |
Distant Metastasis |
| Staging Grouping |
| I |
T1 |
NO |
MO |
| II |
T2 |
NO |
MO |
| III |
T1 |
N1 |
MO |
| |
T2 |
N1 |
MO |
| |
T3a |
NO |
MO |
| |
T3a |
N1 |
MO |
| |
T3b |
NO |
MO |
| |
T3b |
N1 |
MO |
| |
T3c |
NO |
MO |
| |
T3c |
N1 |
MO |
| IV |
`T4T4 |
NO |
MO |
| |
Any T |
N2 |
MO |
| |
Any T |
Any N |
M1 |
References
- Bostwick DG, Eble JN: Diagnosis and classification of renal cell carcinoma. Urol Clin N Am 26:627-635, 1999.
- Caddeddu JA, Ono Y, Clayman RV, et al: Laparoscopic nephrectomy for renal cell cancer: Evaluation of efficacy and safety: A multicenter experience. Urology 52:773-777, 1998.
- Levy DA, Slaton JW, Swanson DA, Dinney CP: Stage specific guidelines for surveillance after radical nephrectomy for local renal cell carcinoma. J Urol 15:1163-1167, 1998.
- Montie JM: Lymphadenectomy for renal cell carcinoma. Semin Urol 7:181-185, 1989.
- Motzer RJ, Bander NH, Nanus DM: Renal-cell carcinoma. N Engl J Med 335:865-875, 1996.
- Novick AC: Renal-sparing surgery for renal cell carcinoma. Urol Clin North Am 20:277-282, 1993.
- Sagalowsky AI, Kadesky KT, Ewalt DM, Kennedy TJ: Factors influencing adrenal metastasis in renal cell carcinoma. J Urol 151:1181-1184, 1994.
- Skinner DG, Pritchett RT, Lieskovsky G, Boyd SD, Stiles QR: Vena caval involvement by renal cell carcinoma. Surgical resection provides meaningful long-term survival. Ann Surg 210:387-394, 1989.
- Sufrin G, Cashon S, Golio A, Murphy GP: Paraneoplastic and serologic syndromes of renal adenocarcinoma. Semin Urol 7:158-171, 1989.
- Yang JC, Topalian SL, Parkinson D, et al: Randomized comparison of high-dose and low-dose intravenous interleukin 2 for the therapy of metastatic renal cell carcinoma: An interim report. J Clin Oncol 12:1572-1576, 1994.
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Renal Cancer 
