CancerGuide: Special Kidney Cancer Section
Rather than repeat information which can be found elsewhere, this guide to kidney cancer grading and staging is intended to point you in the right direction for detailed definitions of stage and grade, and to give you some perspective on what it means. For a variety of reasons, including that you might not want to see it, I don't directly present statistical information. Towards the end of the article, I do point to a review of prognostic factors and statistical information elsewhere on the web.
Investigating Your Case
Staging for Renal Cell Cancer
There are two similar staging systems in use, by far the most common is the current AJCC TNM system. Occasionally the older Robson system is used. The newer system is better though still imperfect.
411Cancer has (Will open in new window)
Stage III actually includes cases with a widely differing prognosis, specifically the prognosis with lymph node involvement is significantly worse than other cases in stage III. Only a small percentage of those with stage III have positive lymph nodes.
Significance of Staging in Kidney Cancer
The grade affects the prognosis, but doesn't currently affect treatment. The treatment is the same for a given stage regardless of the grade. Grade also correlates with stage in that larger tumors tend to be higher grade.
The most widely used and most predictive grading system for renal cell cancer is the "Fuhrman Nuclear Grade". Your pathology report should use the Fuhrman Grade. Fuhrman grade is on a scale of I-IV, where grade I carries the best prognosis and grade IV the worst.
Nuclear grade means that the system is based on just the appearance of the nuclei of the cancer cells, rather than the appearance or structure of the cells as a whole. Nuclear characteristics used in the Fuhrman Grade particularly indicate how actively the cells are making protein.
Nuclear Characteristics Used in the Fuhrman System
Statistics: Stage, Grade and Other Prognostic Factors
Stage and grade aren't the only important factors. In reality, a great deal of why the prognosis varies so much is simply unknown and, although it's clear that the known prognostic factors matter quite a bit, there simply isn't any way to determine the prognosis with any great precision. A terse review of prognostic factors from Medical Algorithms (Opens in new window) gives survival statistics based on stage, grade, and several other recent models which incorporate various other prognostic factors.
NOTE: To access the articles on the prognostic factors for RCC, you must first go to www.medal.org and register (free). Then log in and choose "27: Oncology/Nonhematologic". That takes you to a new page and you have to scroll down until you find Renal Cell Carcinoma. The information is broken up into over 20 separate links. (Reviewed 7/07)
You'll also find precise definitions of the Fuhrman grade and several staging systems. The review is notably missing any detailed appreciation of the effect of the sub-type of RCC on prognosis. WARNING: Don't look at this unless you really want to see the statistics.
This CancerGuide Page By Steve Dunn. © Steve Dunn
Page Created: August 12, 2003, Last Updated: July 5, 2007