Pathologic 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 kidney

NAACCR Item

NAACCR #880

Pathologic T	Pathologic T Display	Description	Registrar Notes
pX	pTX	Primary tumor cannot be assessed	Pathologic classification criteria met, evaluation done: Physician unable to assess T Surgical resection of primary tumor, extension not stated Tumor size (TS) unknown for T categories where TS needed to determine T Physician assigns pTX, no other information available to determine T
p0	pT0	No evidence of primary tumor
p1	pT1	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]
p1A	pT1a	Tumor 4 cm or less	Stated as T1a
p1B	pT1b	Tumor more than 4 cm but not more than 7 cm	Stated as T1b
p2	pT2	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]
p2A	pT2a	Tumor more than 7 cm but not more than 10 cm	Stated as T2a
p2B	pT2b	Tumor more than 10 cm, limited to the kidney	Stated as T2b
p3	pT3	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]
p3A	pT3a	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
p3B	pT3b	Tumor grossly extends into vena cava below diaphragm	Inferior vena cava (IVC) below diaphragm Stated as T3b
p3C	pT3c	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
p4	pT4	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	Pathologic classification criteria not met Pathologic classification criteria met, evaluation done: Results not documented in patient record No surgical resection of known primary tumor (not T0) Resection insufficient for site-specific pathologic assessment No surgical resection of primary tumor and there isn’t a positive biopsy of a structure in the highest T category and highest N category Evidence of metastatic disease (pM1), no other workup Only Pathologic Stage Group documented (no T, N, or M information available)