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Adrenal Cortex (ICD‐O‐3 C74.0)
This classification applies only to carcinomas of the adrenal cortex. It does not apply to tumours of the adrenal medulla or sarcomas. The following are the procedures for assessing T, N, and M categories: T categories Physical examination and imaging N categories Physical examination and imaging M categories Physical examination and imaging
Regional Lymph Nodes The regional lymph nodes are the hilar, abdominal para‐aortic, and paracaval nodes. Laterality does not affect the N categories.
TNM Clinical Classification T – Primary Tumour TX Primary tumour cannot be assessed T0 No evidence of primary tumour T1 Tumour 5 cm or less in greatest dimension, no extra‐adrenal invasion T2 Tumour greater than 5 cm, no extra‐adrenal invasion T3 Tumour of any size with local invasion, but not invading adjacent organs* T4 Tumour of any size with invasion of adjacent organs* Note * Adjacent organs include kidney, diaphragm, great vessels (renal vein or vena cava), pancreas, and liver.
TNM Classification of Malignant Tumours, Eighth Edition. Edited by James D. Brierley, Mary K. Gospodarowicz and Christian Wittekind. © 2017 UICC. Published 2017 by John Wiley & Sons, Ltd.
Adrenal Cortex
Rules for Classification
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Adrenal Cortex
N – Regional lymph nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in regional lymph node(s)
M – Distant Metastasis M0 No distance metastasis M1 Distant metastasis
pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8.
Stage Stage I Stage II Stage III Stage IV
T1 T2 T1, T2 T3, T4 Any T
N0 N0 N1 N0, N1 Any N
M0 M0 M0 M0 M1
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Prognostic Factors Grid Prognostic factors for survival in ACC Prognostic factors
Tumour related
Essential
T, N, M categories Biochemical status:
Environment related Resectability
Improved survival in patients with functional tumours
Additional
Response to mitotane
New and promising
Molecular profile: ▪▪
Higher tumour grade, described by Ki‐67 or mitotic rate is associated with poorer prognosis
▪▪
Chromosomal aberrations associated with poor survival: gain in chromosomes 6, 7, 12 and 19; and loss in chromosomes 3, 8, 10, 16, 17 and 19
▪▪
Increasing degree of aberration is associated with shorter survival
Age
Source: UICC Manual of Clinical Oncology, Ninth Edition. Edited by Brian O’Sullivan, James D. Brierley, Anil K. D’Cruz, Martin F. Fey, Raphael Pollock, Jan B. Vermorken and Shao Hui Huang. © 2015 UICC. Published 2015 by John Wiley & Sons, Ltd.
Adrenal Cortex
▪▪
Host related