Adrenal Cancer Stages

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. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.

To determine the cancer’s stage after an adrenal cancer diagnosis, doctors try to answer these questions:

• How large is the cancer?
• Has the cancer grown into nearby structures or organs?
• Has the cancer spread to nearby lymph nodes or to distant organs?

The stage of adrenal cancer is based on the results of physical exams, biopsies, and imaging tests (CT or MRI scan, x-rays, PET scan, etc.), 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.

Understanding your adrenal cancer stage

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:

• T describes the size of the main (primary) tumor and whether it has grown into nearby areas.
• N indicates any cancer spread to lymph nodes near the adrenal gland (regional lymph nodes). Lymph nodes are small bean-sized collections of immune system cells, to which cancers often spread first.
• M indicates if the cancer has spread (metastasized) to distant sites, such as other organs or lymph nodes that are not near the adrenal gland (distant lymph nodes).

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:

• TX: Main tumor cannot be assessed due to lack of information
• T0: No evidence of a primary tumor
• NX: Regional lymph nodes cannot be assessed due to lack of information