Classification, Grading, and Staging
Recent advancements in the understanding of the genetics of RCC have led to a new pathological classification of five different subtypes of RCCs: clear cell, papillary, chromophobe, collecting duct carcinoma (Bellini Duct tumor), and renal carcinoma unclassified (renal medullary carcinoma). This classification is primarily based on cytologic appearance and the cell origin in combination with growth pattern and genetic alterations (Campbell & Lane, 2012; Kennedy et al., 1990).
The grading of RCC is based on the morphology of a neoplasm with hematoxylin and eosin (H&E) staining on microscopy. The most popular and widely used system for grading RCC is a nuclear grading system described by Fuhrman, Lasky, and Limas in 1982. This system categorizes RCC into one of four grades based on nuclear characteristics and has been shown to correlate with prognosis (see Table 3).
The Tumor Node Metastasis (TNM) staging system is used for staging all histologic variants of renal carcinoma. This system assesses the anatomic extent of disease and has been shown to correlate with prognosis. A revision was proposed in 2010 and is supported by the American Joint Committee on Cancer (AJCC) (2010) (see Table 4).
Another commonly used staging system ranges from Stage I to IV based on anatomic stage and places into a prognostic group (see Table 5). It is hoped that with greater knowledge of tumor genetics and immunohistochemistry, there will be an improved ability to make prognoses and appropriately target therapy to those who would most benefit (Odonez & Hank, 2011).
Urol Nurs. 2012;32(4):182-190. © 2012 Society of Urologic Nurses and Associates