STAGE OF ADRENAL CANCER
Staging is the process of finding out how far the cancer has spread. It's very important because treatment options and the course of the disease as well as prognosis (outlook) are determined by the stage of the cancer. Two major staging systems are used: the American Joint Committee on Cancer (AJCC) TNM staging system and the ENSAT (European Network for the Study of Adrenal Tumors) staging system. Both are based on the same TNM categories. They differ on how they combine those categories to determine the final stage (this is known as stage grouping).
TNM describes 3 key pieces of information:
Numbers or letters appearing after T, N, and M provide more details about each of these factors. The numbers 0 through 4 indicate increasing severity. The letter X means cannot be assessed because the information is not available.
Once the values for T, N, and M are determined, they are combined together to decide the stage. This is called stage grouping.
T categories for adrenal cancer
T1: the tumor is 5 cm (about 2 inches) or less in size and it has not grown into tissues outside the adrenal gland
T2: the tumor is greater than 5 cm (2 inches) in size and it has not grown into tissues outside the adrenal gland
T3: the tumor is growing in the fat that surrounds the adrenal gland. The tumor can be any size.
T4: the tumor is growing into nearby organs, such as the kidney, pancreas, spleen, and liver. The tumor can be any size.
N categories
N0: the cancer has not spread to nearby lymph nodes
N1: the cancer has spread to nearby lymph nodes
M categories
M0: the cancer has not spread to distant organs or tissues (like liver, bone, brain)
M1: the cancer has spread to distant sites
Stage groupings for adrenal cancer in the AJCC system
Stage I
T1, N0, M0: The cancer is smaller than 5 cm (2 inches) and has not grown into surrounding tissues or organs. The cancer has not spread to lymph nodes (N0) or other body parts (M0).
Stage II
T2, N0, M0: The cancer is larger than 5 cm (2 inches) but still has not grown into surrounding tissues or organs. The cancer has not spread to lymph nodes (N0) or other body parts (M0).
Stage III
Either of the following:
T1 or T2, N1, M0: The tumor can be any size but it has not started growing outside the adrenal gland (T1 or T2). The cancer has spread to nearby lymph nodes (N1) but not to distant sites (M0).
OR
T3, N0, M0: The cancer has grown into the fat outside the adrenal gland (T3). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
Stage IV
Either of the following:
T3, N1, M0: the cancer has grown into the fat outside of the adrenal gland (T3) and it has spread to nearby lymph nodes (N1); it has not spread to distant body sites (M0)
OR
T4, N0 or N1, M0: the cancer has grown from the adrenal gland into organs or tissues nearby (T4) It may (N1) or may not (N0) have spread to nearby lymph nodes, but it has not spread to distant sites (M0)
OR
Any T, any N, M1: The cancer has spread to distant sites (M1). It can be any size and may or may not have spread to nearby tissues or lymph nodes.
Stage groupings for adrenal cancer in the ENSAT system
In the ENSAT system, stages I and II are the same as they are in the AJCC system. Stages III and IV are different.
Stage III
Either
T3 or T4, N0, M0: the cancer has grown into the fat outside of the adrenal gland (T3) or into nearby organs or tissues (T4). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
OR
Any T, N1, M0: the cancer can be any size and may have grown into nearby tissues (any T). It has spread to nearby lymph nodes (N1), but not to distant sites (M0).
Stage IV
Any T, any N, M1: The cancer has spread to distant sites (M1). It can be any size and may or may not have spread to nearby tissues or lymph nodes.
Survival rates by stage for adrenal cancer
Survival rates are often used by doctors as a standard way of discussing a person's prognosis (outlook). Some patients with cancer want to know the survival statistics for people in similar situations, while others might not find the numbers helpful, or not want to know them. If you decide you don’t want to know them,
The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Of course, many people live much longer than 5 years (and many are cured).
Five-year relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a better way to see the impact of the cancer on survival.
In order to get 5-year survival rates, doctors have to look at people who were treated at least 5 years ago. Improvements in treatment since then may result in a more favorable outlook for people now being diagnosed with adrenal cortical cancer.
Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they cannot predict what will happen in any particular person's case. Many other factors besides stage can affect a person's outlook, such as the grade of their cancer, the treatment they receive, their age, and overall health. Your doctor can tell you how the numbers below may apply to you, as he or she is familiar with the aspects of your particular situation.
The numbers below come from the National Cancer Institute's SEER database, and are based on people diagnosed between 1988 and 2001. The SEER database does not list survival statistics by AJCC or ENSAT stages. Instead, it divides patients into 3 groups: localized, regional, and distant. Localized means that the cancer hasn't grown outside of the adrenal gland at diagnosis (like stages I and II). Regional means that the cancer has grown into nearby tissues or has spread to nearby lymph nodes (like ENSAT stage III). Distant means that the cancer has spread further to distant sites (like ENSAT stage IV).
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