Renal cell carcinoma staging: pitfalls, challenges, and updates

Sean R. Williamson, Kanika Taneja, Liang Cheng

Research output: Contribution to journalReview article

14 Scopus citations


Renal cell carcinoma (RCC) is unusual among cancers in that it often grows as a spherical, well-circumscribed mass. Increasing tumour size influences the pathological pT stage category within pT1 and pT2, with cutoffs of 40, 70 and 100 mm; however, with increasing size also comes a sharp increase in the likelihood of renal sinus or renal vein tributary invasion, such that clear cell RCC rarely reaches 70 mm without invading one of these. To clarify some previous challenges in assigning tumour stage, the American Joint Committee on Cancer 2016 tumor–node–metastasis classification has removed the requirements than vein invasion be recognised grossly and that vein walls contain muscle for the diagnosis of vein invasion. Renal pelvis invasion has also been added as an additional route to pT3a. Multinodularity or finger-like extensions from a renal mass should be viewed with great suspicion for the possibility of vein or renal sinus invasion, and, as tumour size increases to over 40–50 mm, thorough sampling of the renal sinus interface should always be undertaken. With increasing interest in adjuvant therapy in renal cancer, the pathologist's role in RCC staging will continue to be an important prognostic parameter and a tool for selection of patients for enrolment in clinical trials.

Original languageEnglish (US)
Pages (from-to)18-30
Number of pages13
Issue number1
StatePublished - Jan 2019


  • AJCC
  • kidney cancer
  • renal cell carcinoma
  • renal sinus
  • tumour staging
  • venous invasion

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

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