Adrenal Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How is adrenal cancer staged?

Staging is the process of finding out how far the cancer has spread. It's very important because treatment options and the course of the disease as well as prognosis (outlook) are determined by the stage of the cancer. Two major staging systems are used: the American Joint Committee on Cancer (AJCC) TNM staging system and the ENSAT (European Network for the Study of Adrenal Tumors) staging system. Both are based on the same TNM categories. They differ on how they combine those categories to determine the final stage (this is known as stage grouping).

TNM describes 3 key pieces of information:

  • T indicates the size of the main (primary) tumor and whether it has grown into nearby areas.
  • N describes how much the cancer has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells that are important in fighting infections.
  • M indicates whether the cancer has spread (metastasized) to other organs of the body (the most common site is the liver).

Numbers or letters appearing after T, N, and M provide more details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means cannot be assessed because the information is not available.

Once the values for T, N, and M are determined, they are combined together to decide the stage. This is called stage grouping.

T categories for adrenal cancer

T1: the tumor is 5 cm (about 2 inches) or less in size and it has not grown into tissues outside the adrenal gland

T2: the tumor is greater than 5 cm (2 inches) in size and it has not grown into tissues outside the adrenal gland

T3: the tumor is growing in the fat that surrounds the adrenal gland. The tumor can be any size.

T4: the tumor is growing into nearby organs, such as the kidney, pancreas, spleen, and liver. The tumor can be any size.

N categories

N0: the cancer has not spread to nearby lymph nodes

N1: the cancer has spread to nearby lymph nodes

M categories

M0: the cancer has not spread to distant organs or tissues (like liver, bone, brain)

M1: the cancer has spread to distant sites

Stage groupings for adrenal cancer in the AJCC system

Stage I

T1, N0, M0: The cancer is smaller than 5 cm (2 inches) and has not grown into surrounding tissues or organs. The cancer has not spread to lymph nodes (N0) or other body parts (M0).

Stage II

T2, N0, M0: The cancer is larger than 5 cm (2 inches) but still has not grown into surrounding tissues or organs. The cancer has not spread to lymph nodes (N0) or other body parts (M0).

Stage III

Either of the following:

T1 or T2, N1, M0: The tumor can be any size but it has not started growing outside the adrenal gland (T1 or T2). The cancer has spread to nearby lymph nodes (N1) but not to distant sites (M0).

OR

T3, N0, M0: The cancer has grown into the fat outside the adrenal gland (T3). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

Stage IV

Either of the following:

T3, N1, M0: the cancer has grown into the fat outside of the adrenal gland (T3) and it has spread to nearby lymph nodes (N1); it has not spread to distant body sites (M0)

OR

T4, N0 or N1, M0: the cancer has grown from the adrenal gland into organs or tissues nearby (T4) It may (N1) or may not (N0) have spread to nearby lymph nodes, but it has not spread to distant sites (M0)

OR

Any T, any N, M1: The cancer has spread to distant sites (M1). It can be any size and may or may not have spread to nearby tissues or lymph nodes.

Stage groupings for adrenal cancer in the ENSAT system

In the ENSAT system, stages I and II are the same as they are in the AJCC system. Stages III and IV are different.

Stage III

Either

T3 or T4, N0, M0: the cancer has grown into the fat outside of the adrenal gland (T3) or into nearby organs or tissues (T4). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).

OR

Any T, N1, M0: the cancer can be any size and may have grown into nearby tissues (any T). It has spread to nearby lymph nodes (N1), but not to distant sites (M0).

Stage IV

Any T, any N, M1: The cancer has spread to distant sites (M1). It can be any size and may or may not have spread to nearby tissues or lymph nodes.


Last Medical Review: 03/19/2014
Last Revised: 04/10/2014