How is renal cell carcinoma (RCC) staged?

Updated: Dec 13, 2018
  • Author: Deborah A Baumgarten, MD, MPH; Chief Editor: Eugene C Lin, MD  more...
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RCCs can be staged by using the American Joint Committee on Cancer TNM ( Tumor, Node, Metastases) classification, as follows:

  • Stage 1 RCCs are 7 cm or smaller and confined to the kidney.

  • Stage 2 RCCs are larger than 7 cm but still organ confined.

  • Stage 3 tumors extend into the renal vein or vena cava, involve the ipsilateral adrenal gland and/or perinephric fat, or have spread to local lymph nodes.

  • Stage 4 tumors extend beyond the Gerota fascia, have spread to local or distant nodes, or have distant metastases.

The American College of Radiology (ACR) Appropriateness Criteria for RCC staging recommends contrast-enhanced multiphasic CT scanning of the abdomen as the diagnostic modality of choice for staging a primary renal tumor. MRI of the abdomen is a suitable substitute when contrast-enhanced CT is contraindicated. If the status of the renal veins and IVC cannot be determined on CT, contrast-enhanced multiphasic 3-D MR venography can be performed. CT of the chest should be used to detect pulmonary metastasis in patients with large or locally advanced tumors. Chest radiography may be sufficient in patients with small primary tumors. In patients with suspicion of metastatic disease based on symptoms, other sites of metastases, or abnormal laboratory findings, brain MRI and bone scans can be performed. [8]

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