Pathologic 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


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)
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
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 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)