Renal Cancer Staging

There are two staging systems in use, the most common is the current AJCC TNM system, and the second is the Robson system.

The grade affects the prognosis, but doesn’t currently affect treatment.

The most widely used and most predictive grading system for renal cell cancer is the Fuhrman Nuclear Grade.

Fuhrman grade is on a scale of I-IV, where grade I carries the best prognosis and grade IV the worst.

Nuclear grade is based on just the appearance of the nuclei of the cancer cells, and indicate how actively the cells are making protein in the nucleoli, size and shape of the nucleus as a whole, and chromatin clumping.

TNM Staging


Tx Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor 7 cm or less in greatest dimension and limited to the kidney
T2 Tumor >7cm in greatest dimension and limited to the kidney
T3 Tumor extends into major veins or invades adrenal gland or perinephric tissue but not beyond Gerota’s fascia
T3a Tumor invades the adrenal gland or perinephric fat but not beyond Gerota’s fascia
T3b Tumor grossly extends into renal vein and vena cava below diaphragm
T3c Tumor grossly extends into the vena cava above the diaphragm
T4 Tumor invades beyond Gerota’s fascia


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