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. Adrenal cortical cancer is staged by the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM system 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 appear after T, N, and M to 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 cortical cancer

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

T2: the tumor is greater than 5 cm (2 inches) in size; it has not grown into tissues outside of 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 cortical cancer

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:

T1or T2, N1, M0: The tumor can be any size but it has not started growing outside of 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 of 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 (N2) 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

Survival rates by stage

The outlook for people with cancers of the adrenal cortex depends on many factors. The most important factor is the stage of the cancer. About 4 in 10 patients are diagnosed with early stage disease (includes stage I and stage II). The rest are divided between stage III and stage IV.

Early stage cancer, when the tumor is small and has not spread, has a very good outlook, and many patients can be cured with surgery alone. Relative 5-year survival rates for people with stage I and stage II are about 65%.

People with more advanced disease where the cancer has spread have a less favorable outlook for survival. Patients with stage III adrenal cortical cancers have relative 5-year survival rates of about 40%, while less than 10% of patients with stage IV live at least 5 years. These numbers are all approximate because there are not many reported cases. The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many of these patients live much longer than 5 years after diagnosis, but 5-year rates are used to produce a standard way of discussing outlook. Five-year relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a more accurate way to see the effect of that cancer on survival. It's also important to remember that 5-year rates are based on patients diagnosed and initially treated more than 5 years ago. Improvements in treatment often result in a more favorable prognosis (outlook) for recently diagnosed patients.

The numbers presented above are from the National Cancer Institute's SEER program, which collects data about cancer cases from all over the country.

Last Medical Review: 03/20/2009
Last Revised: 03/20/2009