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Staging and grading RCC

Created: 5/8/2006
Updated: 3/4/2007


Staging and Grading Renal Cell Carcinoma


Fuhrman nuclear grading system is based on nuclear size and shape, number and size of nucleoli, and clumping of chromatin. These characteristics give an indication of how actively the cells are making protein.

  1. Well differentiated
  2. Moderately differentiated
  3. 3/4. Poorly differentiated/undifferentiated


Staging is by the 2002 TNM classification following histological confirmation of the disease

Summary of TNM for RCC

T1 = 7 cm or less; limited to the kidney
T1a = 4cm or less
T1b = 4-7cm

T2 >7cm; limited to the kidney

T3 Adrenal or perinephric invasion; major vein involvement
T3a Adrenal or perinephric invasion
T3b Renal vein(s); IVC below diaphragm
T3c IVC above diaphragm

T4 beyond Gerota’s

N1 Single node
N2 More than one node

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