Clinical T
This input is used for staging
Notes
**Note 1:** Assign 88 for in situ cases (behavior code /2). TNM does not include an in situ category for kidney parenchyma tumors. **Note 2:** Gerota fascia is a fibrous tissue sheath surrounding the kidney and suprarenal or adrenal gland. The perirenal fat, renal capsule, and renal parenchyma lie below the fascia. **Note 3:** The parenchyma of the kidney includes the following structures * Cortex (outer layer of kidney), renal columns; medulla, medullary rays, renal pyramids, and renal papillae; nephrons (renal corpuscle, loops of Henle, proximal and distal tubules, collecting duct); glomerulus and surrounding Bowman's capsule **Note 4:** The most common site for renal parenchymal cancer to develop is in the proximal convoluted tubule. * Tumor extension from one of these structures into another is assigned T1a - T2b depending on size in the absence of further involvement **Note 5:** Tumor size must be known to assign a value of T1 or T2. You may use a physician’s statement of the T category if this is the only information in the medical record. * If the tumor appears to be in the T1 or T2 categories, but no size or category is specified, assign TX **Note 6:** Assign the appropriate T category (T1, T2) based on the tumor size for the following descriptions Invasive cancer confined to kidney cortex and/or medulla Invasion of renal capsule Renal pelvis or calyces involved Separate focus of tumor in renal pelvis/calyx Confined to kidney Localized, NOS **Note 7:** Information about invasion beyond the capsule, venous involvement, and ipsilateral adrenal gland involvement is collected in this field for anatomic staging. * This information is also collected in **Site-Specific Factor 1, Site-Specific Factor 2, and Site-Specific Factor 3**, as these factors may have an independent effect on prognosis **Note 8:** Direct extension to OR involvement of other structures is coded in M (distant metastasis). This includes: * Contralateral kidney; contralateral ureter; liver from left kidney; spleen from right kidneyNAACCR Item
NAACCR #940| Clinical T | Clinical T Display | Description | Registrar Notes |
|---|---|---|---|
| cX | cTX | Primary tumor cannot be assessed | Clinical classification criteria met, evaluation done: Physician unable to assess T Extension cannot be determined Tumor size (TS) unknown for T categories where TS needed to determine T Physician assigns cTX, no other information available to determine T |
| c0 | cT0 | No evidence of primary tumor | |
| c1 | cT1 | Tumor 7 cm or less in greatest dimension LIMITED to the kidney |
Note: T1 has subcategories of T1a and T1b. Assign T1 only when there is no information available to assign one of the subcategories Stated as T1 [NOS] |
| c1A | cT1a | Tumor 4 cm or less | Stated as T1a |
| c1B | cT1b | Tumor more than 4 cm but not more than 7 cm | Stated as T1b |
| c2 | cT2 | Tumor more than 7 cm in greatest dimension LIMITED to the kidney |
Note: T2 has subcategories of T2a and T2b. Assign T2 only when there is no information available to assign one of the subcategories Stated as T2 [NOS] |
| c2A | cT2a | Tumor more than 7 cm but not more than 10 cm | Stated as T2a |
| c2B | cT2b | Tumor more than 10 cm, limited to the kidney | Stated as T2b |
| c3 | cT3 | Tumor extends into major veins or perinephric tissues but Not into the ipsilateral adrenal gland and not beyond Gerota fascia |
Note: T3 has subcategories of T3a, T3b, and T3c. Assign T3 only when there is no information available to assign one of the subcategories Inferior vena cava (IVC), NOS Stated as T3 [NOS] |
| c3A | cT3a | Tumor grossly extends into: Renal vein or its segmental (muscle containing) branches, OR Tumor invades: Perirenal and/or renal sinus fat (peripelvic) fat but not beyond Gerota fascia |
Perirenal (perinephric) tissue/fat Renal (Gerota) fascia Renal sinus fat Blood vessels: Extrarenal portion of renal vein or segmental (muscle containing) branches Hilar blood vessel Perirenal vein Renal artery Renal vein, NOS Tumor thrombus in a renal vein, NOS Stated as T3a |
| c3B | cT3b | Tumor grossly extends into vena cava below diaphragm | Inferior vena cava (IVC) below diaphragm Stated as T3b |
| c3C | cT3c | Tumor grossly extends into vena cava above the diaphragm OR Invades the wall of the vena cava |
IVC above diaphragm or invades wall of IVC Stated as T3c |
| c4 | cT4 | Tumor invades beyond Gerota fascia (including contiguous extension into the ipsilateral adrenal gland) |
Ipsilateral adrenal (suprarenal) gland (Noncontiguous ipsilateral adrenal gland involvement coded in M field and not T) Ipsilateral adrenal gland plus blood vessels and/or IVC below diaphragm Ipsilateral adrenal gland plus IVC above diaphragm or wall of IVC Extension beyond Gerota fascia to: Ascending colon from right kidney Descending colon from left kidney Diaphragm Duodenum from right kidney Peritoneum Psoas muscle Quadratus lumborum muscle Tail of pancreas Ureter, including implant(s), ipsilateral Beyond Gerota fascia, NOS Other extension: Liver from right kidney Retroperitoneal soft tissue Ribs Spleen from left kidney Stomach Further contiguous extension: Aorta Other direct extension EXCLUDING: contralateral kidney and ureter, liver from left kidney, or spleen from right kidney Stated as T4 |
| 88 | 88 | Not applicable | Primary site/histology not TNM defined In situ case but no pTis is defined by TNM Death certificate only (DCO) case |
| <BLANK> | BLANK | See Registrar Notes | Clinical classification criteria not met Clinical classification criteria met, evaluation done: No information about diagnostic workup Results not documented in record Clinical evaluation of primary tumor not done or unknown if done Tumor first detected on surgical resection (no clinical workup) Evidence of metastatic disease [(cM1) or (pM1)], no other workup Only Clinical Stage Group documented (no T, N, or M information available) |