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. Adrenal cortical cancer is staged by the American Joint Committee on Cancer (AJCC) TNM staging system. The TNM system describes 3 key pieces of information:

• T indicates the size of the main (primary) tumor and whether it has grown into nearby areas.

• N describes how much the cancer has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells that are important in fighting infections.

• M indicates whether the cancer has spread (metastasized) to other organs of the body. (The most common site is the liver.)

Numbers or letters appear after T, N, and M to 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 cortical cancer

T1: the tumor is 5 cm (about 2 inches) or less in size and it has not grown into tissues outside of the adrenal gland

T2: the tumor is greater than 5 cm (2 inches) in size; it has not grown into tissues outside of 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