Staging

Criteria for TNM Clinical Staging: Physical examination and history, histologic confirmation of tumor, urinary endoscopy, urinary cytology, pyelography, imaging (radiographic and computer assisted), and other evaluations to determine metastatic involvement; laparotomy may be included in clinical staging.

Criteria for TNM Pathologic Staging: Radical nephrectomy, including removal of the primary tumor, entire kidney, adrenal gland, perinephric fat, Gerota’s fascia, renal vein and lymph node resection are required for pathologic staging. For renal pelvis and ureteral cancers, the ureter and a portion of the bladder (bladder cuff) should also be resected.

AJCC 6th Edition--Kidney		AJCC 6th Edition—Renal Pelvis & Ureter
Stage I	Primary 7cm or less	Stage 0a	Noninvasive papillary carcinoma
Stage II	Primary > 7cm	Stage 0is	Carcinoma in situ
Stage III	Perinephric tissue* within Gerota’s fascia	Stage I	Subepithelial connective tissue invaded
	One positive regional node	Stage II	Muscularis invaded
	Vena cava	Stage III	Beyond muscularis into peripelvic/periureteric fat or renal parenchyma
Stage IV	Beyond Gerota’s fascia > 1 positive regional node Distant metastases	Stage IV	Adjacent organs, through kidney into perihephric fat, any positive node(s), distant metastasis

*adrenal gland, fat, renal veins

Collaborative Stage Elements

Fore more details on Collaborative Stage, see the CS module.