Changes in Renal Cell Carcinoma Pathologic Staging and Histologic Grading

Share this content:
Tumor categories are influenced by tumor size, but invasion of structures must be also considered.
Tumor categories are influenced by tumor size, but invasion of structures must be also considered.

The most important prognostic factor when treating renal cell carcinoma (RCC) is tumor staging. Larger tumors (greater than 4 cm to 5 cm) need to be carefully assessed for the possibility of renal sinus invasion, according to a new review published Surgical Pathology Clinics.1Kanika Taneja,MBBS, MD, DNB, and Sean R. Williamson, MD, both of the Henry Ford Health System, Henry Ford Hospital in Detroit, Michigan, reported that pathologic primary tumor categories are influenced by tumor size. However, invasion of structures, including the renal sinus, perinephric fat, and the renal vein or segmental branches, must be considered when managing patients with RCC.

The authors noted that the invasion can be subtle. However, awareness of each patient's unique characteristics may be critical for clinical decision-making. The renal sinus contains abundant veins and lymphatics and it is theorized that this may provide increased opportunity for tumor dissemination compared with the perinephric fat. 

Continue Reading Below

The review examines the challenges in pathologic staging and grade reporting. It also discusses the latest updates on classification schemes from the World Health Organization and the American Joint Commission on Cancer. The researchers reported that the likelihood of renal sinus invasion increases dramatically with increased tumor size. Satellite nodules adjacent to or away from a large renal mass can indicate retrograde spread of tumor within vein branches, according to the authors. 

The authors concluded by noting that the current American Joint Commission on Cancer staging system has modified the category of pT3a. It has removed the requirements that renal vein invasion be identified grossly and that vein walls must contain muscle to be categorized as pT3a.

Reference

  1. Taneja K, Williamson SR. Updates in pathologic staging and histologic grading carcinoma of renal cell carcinoma.Surg Pathol Clin. 2018;11:797-812. doi: 10.1016/j.path.2018.07.004

Related Resources

You must be a registered member of Cancer Therapy Advisor to post a comment.

Sign Up for Free e-newsletters



Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Prostate Cancer Regimens Drugs
Rare Cancers Regimens
Renal Cell Carcinoma Regimens Drugs
Skin Cancer Regimens Drugs
Urologic Cancers Regimens Drugs