Wilms' tumor (nephroblastoma) may be classified using the TNM scheme.
Clinical TNM Classification
|
TNM |
Designation |
Description |
|
T |
TX |
primary tumor cannot be assessed |
|
|
T0 |
no evidence of primary tumor |
|
|
T1 |
unilateral tumor <= 80 square centimeters in cross-sectional area (including the kidney) |
|
|
T2 |
unilateral tumor > 80 square centimeters in cross-sectional area (including the kidney) |
|
|
T3 |
unilateral tumor with rupture before treatment |
|
|
T4 |
bilateral tumors |
|
N |
NX |
regional lymph nodes cannot be assessed |
|
|
N0 |
no metastasis to regional lymph nodes |
|
|
N1 |
regional lymph node metastasis |
|
M |
MX |
presence of distant metastasis cannot be assessed |
|
|
M0 |
no distant metastasis |
|
|
M1 |
distant metastasis present |
where:
• cross-sectional area on radiographs = (vertical length in cm) * (horizontal length in cm)
Pathologic TNM Classification
|
TNM |
Designation |
Description |
|
pT |
pTX |
primary tumor cannot be assessed |
|
|
pT0 |
no evidence of primary tumor |
|
|
pT1 |
intrarenal tumor completely encapsulated; excision complete and margins histologically free |
|
|
pT2 |
tumor invades beyond the capsule or renal parenchyma; excision complete |
|
|
pT3 |
tumor invades beyond the capsule or renal parenchyma; excision incomplete or preoperative rupture or intraoperative rupture |
|
|
pT3a |
microscopic residual tumor limited to tumor bed |
|
|
pT3b |
macroscopic residual tumor, or spillage, or malignant ascites |
|
|
pT3c |
surgical exploration; tumor not resected |
|
|
pT4 |
bilateral tumors |
|
pN |
pNX |
regional lymph nodes cannot be assessed |
|
|
pN0 |
no metastasis to regional lymph nodes |
|
|
pN1 |
regional lymph node metastasis |
|
|
pN1a |
regional lymph node metastasis completely resected |
|
|
pN1b |
regional lymph node metastasis incompletely resected |
|
pM |
pMX |
presence of distant metastasis cannot be assessed |
|
|
pM0 |
no distant metastasis |
|
|
pM1 |
distant metastasis present |
where:
• Invasion beyond the renal parenchyma = breach of renal capsule, involvement of renal blood vessels outside of the kidney, infiltration of renal pelvis, infiltration of ureter, infiltration of peripelvic or pericalyceal fat.
Clinical Staging
|
Stage |
TNM |
|
I |
T1 N0 M0 |
|
II |
T2 N0 M0 |
|
III |
T1 N1 M0 T2 N1 M0 T3 N0-N1 M0 |
|
IVA |
T1 N0-N1 M1 T2 N0-N1 M1 T3 N0-N1 M1 |
|
IVB |
T4 N0-N1 M0-M1 |
Specialty: Hematology Oncology, Surgery, general, Nephrology
ICD-10: ,
