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After someone is diagnosed with adrenal cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how far the cancer has spread in the body. It helps determine how serious the cancer is and how best to treat it.
To determine the cancer’s stage after an adrenal cancer diagnosis, doctors try to answer these questions:
The stage of adrenal cancer is based on the results of physical exams, biopsies, and imaging tests (CT, MRI, PET scan), which are described in Tests for Adrenal Cancer, as well as the results of surgery.
The adrenal cancer stages range from stages I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
A staging system is a standard way for the cancer care team to describe how far a cancer has spread. Two major staging systems used for adrenal cancer are 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, which are based on 3 key pieces of information:
Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage (numbered I through IV).
The staging system in the table below uses the pathologic stage. It is based on the results of physical exam, biopsy, imaging tests, and the results of surgery. This is likely to be more accurate than clinical staging, which only takes into account the tests done before surgery.
Adrenal cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand.
ENSAT stage | AJCC Stage |
Stage grouping |
Stage description |
I | I |
T1 N0 M0 |
The tumor is 5 cm (about 2 inches) or less in size and it has not grown into tissues outside the adrenal gland (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0). |
II | II |
T2 N0 M0 |
The tumor is greater than 5 cm (2 inches) in size and it has not grown into tissues outside the adrenal gland (T2). It has not spread to nearby lymph nodes (N0) or distant sites (M0). |
III | III |
T1 N1 M0 |
The tumor is 5 cm (about 2 inches) or less in size and it has not grown into tissues outside the adrenal gland (T1). The cancer has spread to nearby lymph nodes (N1) but not to distant sites (M0). |
OR | |||
T2 N1 M0 |
The tumor is greater than 5 cm (2 inches) in size and it has not grown into tissues outside the adrenal gland (T2). The cancer has spread to nearby lymph nodes (N1) but not to distant sites (M0). |
||
OR | |||
T3 Any N M0 |
The tumor is growing in the fat that surrounds the adrenal gland. The tumor can be any size (T3). It might or might not have spread to nearby lymph nodes (Any N0). It has not spread to distant sites (M0). |
||
OR | |||
T4 Any N M0 |
The tumor is growing into nearby organs, such as the kidney, pancreas, spleen, and liver or large blood vessels (renal vein or vena cava). The tumor can be any size (T4). It may or may not have spread to nearby lymph nodes (Any N). It has not spread to distant organs (M0). |
||
IV | IV |
Any T Any N M1 |
The cancer has spread to distant sites like the liver or lungs (M1). It can be any size (Any T) and may or may not have spread to nearby tissues (Any T) or lymph nodes (Any N). |
The following additional categories are not listed on the table above:
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Adrenal Cortical. In: AJCC Cancer Staging Manual. 8th ed. New York: Springer. 2017:911-918.
Last Revised: October 1, 2024
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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