Renal cell carcinoma classification: Difference between revisions
Jump to navigation
Jump to search
Rim Halaby (talk | contribs) |
Rim Halaby (talk | contribs) |
||
| Line 68: | Line 68: | ||
====TNM System==== | ====TNM System==== | ||
The TNM classification system for staging of clear cell renal carcinoma is commonly used. | The TNM classification system for staging of clear cell renal carcinoma is commonly used. The following TNM classification is based on the American Joint Committee Cancer (AJCC), the American College of Radiology (ACR), and the Union for International Cancer Control (UICC). | ||
{| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center" | {| border="1" style="border-collapse:collapse; text-align:left;" cellpadding="5" align="center" | ||
|+ '''''TNM Classification System of Renal Cell Carcinoma Staging''''' | |+ ''''' TNM Classification System of Renal Clear Cell Carcinoma Staging''''' | ||
| bgcolor="#d9ff54"|'''T.N.M''' || bgcolor="#d9ff54"|'''Stage''' | | bgcolor="#d9ff54"|'''T.N.M''' || bgcolor="#d9ff54"|'''Stage''' | ||
|- | |- | ||
| bgcolor="#ececec"|'''Primary Tumor (T)''' || '''T0''': No evidence of primary tumor <br>'''T1''': Tumor | | bgcolor="#ececec"|'''Primary Tumor (T)''' || '''TX''': Primary tumor cannot be assessed <br> '''T0''': No evidence of primary tumor <br>'''T1''': Tumor 7 cm or less in greatest dimension, limited to the kidney <br> '''T1a''': Tumor 4 cm or less in greatest dimension, limited to the kidney <br> '''T1b''': Tumor more than 4 cm but not more than 7 cm in greatest dimension, limited to the kidney <br> '''T2''': Tumor more than 7 cm in greatest dimension, limited to the kidney <br> '''T2a''': Tumor more than 7 cm but less than or equal to 10 cm in greatest dimension, limited to the kidney <br> '''T2b''': Tumor more than 10 cm, limited to the kidney <br> '''T3''': Tumor extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota's fascia <br> '''T3a''': Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota's fascia <br> '''T3b''': Tumor grossly extends into the vena cava below the diaphragm <br> '''T3c''': Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava'''T4''': Tumor invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland) | ||
|- | |- | ||
| bgcolor="#ececec"|'''Regional Lymph Nodes (N)''' || ''' | | bgcolor="#ececec"|'''Regional Lymph Nodes (N)''' || '''NX''': Regional lymph nodes (LN) cannot be assessed <br>'''N0''': No regional 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 | ||
|} | |} | ||
To note, proposals in December 2013 to amend the TNM staging of renal clear cell carcinoma have emerged following a 41.7 month follow-up of 122 patients with pT3a renal clear cell carcinoma.<ref name="pmid23816525">{{cite journal| author=Baccos A, Brunocilla E, Schiavina R, Borghesi M, Rocca GC, Chessa F et al.| title=Differing risk of cancer death among patients with pathologic t3a renal cell carcinoma: identification of risk categories according to fat infiltration and renal vein thrombosis. | journal=Clin Genitourin Cancer | year= 2013 | volume= 11 | issue= 4 | pages= 451-7 | pmid=23816525 | doi=10.1016/j.clgc.2013.05.006 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23816525 }} </ref> Baccos and colleagues concluded that fat and/or renal vein invasion are important prognostic factors that play a major role in patient survival and should be considered in the TNM staging. Patients with both fat invasion and renal vein thrombosis have worse survival rates than those with only one element. | |||
==References== | ==References== | ||
Revision as of 18:44, 28 December 2013
|
Renal cell carcinoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Renal cell carcinoma classification On the Web |
|
American Roentgen Ray Society Images of Renal cell carcinoma classification |
|
Risk calculators and risk factors for Renal cell carcinoma classification |
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
| 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 |
Hereditary Forms
| 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 |
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]
| 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 |
TNM System
The TNM classification system for staging of clear cell renal carcinoma is commonly used. The following TNM classification is based on the American Joint Committee Cancer (AJCC), the American College of Radiology (ACR), and the Union for International Cancer Control (UICC).
| T.N.M | Stage |
| Primary Tumor (T) | TX: Primary tumor cannot be assessed T0: No evidence of primary tumor T1: Tumor 7 cm or less in greatest dimension, limited to the kidney T1a: Tumor 4 cm or less in greatest dimension, limited to the kidney T1b: Tumor more than 4 cm but not more than 7 cm in greatest dimension, limited to the kidney T2: Tumor more than 7 cm in greatest dimension, limited to the kidney T2a: Tumor more than 7 cm but less than or equal to 10 cm in greatest dimension, limited to the kidney T2b: Tumor more than 10 cm, limited to the kidney T3: Tumor extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota's fascia T3a: Tumor grossly extends into the renal vein or its segmental (muscle containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond Gerota's fascia T3b: Tumor grossly extends into the vena cava below the diaphragm T3c: Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cavaT4: Tumor invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland) |
| Regional Lymph Nodes (N) | NX: Regional lymph nodes (LN) cannot be assessed N0: No regional 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 |
To note, proposals in December 2013 to amend the TNM staging of renal clear cell carcinoma have emerged following a 41.7 month follow-up of 122 patients with pT3a renal clear cell carcinoma.[3] Baccos and colleagues concluded that fat and/or renal vein invasion are important prognostic factors that play a major role in patient survival and should be considered in the TNM staging. Patients with both fat invasion and renal vein thrombosis have worse survival rates than those with only one element.
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ Baccos A, Brunocilla E, Schiavina R, Borghesi M, Rocca GC, Chessa F; et al. (2013). "Differing risk of cancer death among patients with pathologic t3a renal cell carcinoma: identification of risk categories according to fat infiltration and renal vein thrombosis". Clin Genitourin Cancer. 11 (4): 451–7. doi:10.1016/j.clgc.2013.05.006. PMID 23816525.