Clinical T

This input is used for staging


**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 kidney


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)
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
Duodenum from right kidney
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
Spleen from left kidney

Further contiguous extension:
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)