Oncologist-approved cancer information from the American Society of Clinical Oncology
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Adrenal Gland Tumor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 2/2013
Stages

Staging is a way of describing where the tumor is located, if it is cancerous, if or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the tumor’s stage, so staging may not be complete until all of the tests, or even the surgical removal of the tumor or adrenal gland, are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis (chance of recovery). There are different stage descriptions for different types of cancer. This section covers the standard staging system for adrenocortical carcinoma.

One tool that doctors use to describe the stage is the TNM system. This system judges three factors: the tumor itself, the lymph nodes around the tumor, and whether the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are four stages for adrenocortical carcinoma: stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor, and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0: There is no primary tumor.

T1: The tumor is 5 centimeters (cm) or less and has not grown outside of the adrenal gland.

T2: The tumor is larger than 5 cm and has not grown outside of the adrenal gland.

T3: The tumor is any size, and it has grown into the area around the adrenal gland but not to nearby organs.

T4: The tumor is any size and has grown into nearby organs, such as the kidney; diaphragm (the
thin muscle under the lungs and heart that separates the chest from the abdomen); larger blood vessels, called the aorta and the vena cava; pancreas; spleen; and liver. 

Node. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near where the tumor started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to regional lymph nodes. 

Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.

M0 (M plus zero): The cancer has not spread to other parts of the body.

M1: The cancer has spread to other parts of the body beyond the nearby organs.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage I: The tumor is 5 cm or less and has not grown beyond the adrenal gland or spread to regional lymph nodes or other parts of the body (T1, N0, M0). 

Stage II: The tumor is larger than 5 cm. It has not grown beyond the adrenal gland or spread to regional lymph nodes or other parts of the body (T2, N0, M0).

Stage III: The tumor is described by the following:

  • It is 5 cm or smaller and has spread to the regional lymph nodes but not to other parts of the body (T1, N1, M0).
  • It is larger than 5 cm and has spread to the regional lymph nodes but not to other parts of the body (T2, N1, M0).
  • It is any size and has grown beyond the adrenal gland but not to nearby organs (T3, N0, M0).    

Stage IV: The tumor is described by the following:

  • It is any size and has grown into the area around the adrenal gland but not to nearby organs. The tumor has spread to regional lymph nodes but not to other parts of the body (T3, N1, M0).
  • It is any size and has spread to nearby organs but not to the lymph nodes or other parts of the body beyond the nearby organs (T4, N0, M0).
  • It is any size and has spread to nearby organs. The tumor has spread to the regional lymph nodes but not to other parts of the body beyond the nearby organs (T4, N1, M0).
  • The tumor has spread to other parts of the body (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that comes back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010), published by Springer-Verlag New York, www.cancerstaging.net.

© 2005-2014 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.

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