Adrenal Gland Tumor: Stages

Approved by the Cancer.Net Editorial Board, 08/2021

ON THIS PAGE: You will learn about how doctors describe a cancerous tumor’s growth or spread. This is called the stage. Use the menu to see other pages.

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 other parts of the body.

Doctors use many diagnostic tests to find out the tumor’s stage. Staging may not be complete until all tests, or even the surgical removal of the tumor or adrenal gland, are finished. Knowing the stage helps the doctor recommend what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of tumors.

TNM staging system

One tool that doctors use to describe the stage of a tumor is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. This section covers the standard staging system for adrenocortical carcinoma, which includes 4 stages: stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for adrenocortical carcinoma.

Tumor (T)

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. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

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 cm or less and has not grown outside the adrenal gland.

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

T3: The tumor can be any size. It has grown into the area around the adrenal gland but has not spread to nearby organs.

T4: The tumor is any size and has grown into any of the following:

  • Nearby tissues or organs, such as the kidney

  • The thin muscle under the lungs and heart that separates the chest from the abdomen, called the diaphragm

  • Larger blood vessels, such as the aorta and the vena cava

  • Pancreas

  • Spleen

  • Liver

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes are found all over the body. 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 the regional lymph nodes.

Metastasis (M)

The “M” in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis.

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 information to say what stage the cancer is.

Stage I: The tumor is 5 cm or smaller and has not grown beyond the adrenal gland. It has not spread to the regional lymph nodes or to 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 has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Seventh Edition (2017), published by Springer International Publishing.

Information about the tumor’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.