The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The most commonly used system to stage adrenal cancer is the TNM system from the American Joint Committee on Cancer. The ENSAT (European Network for the Study of Adrenal Tumors) staging system is also sometimes used. Both systems are based on the TNM categories. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

• T tells how far the main tumor has spread into nearby tissue.

• N tells if the lymph nodes in the area of the original tumor have cancer in them.

• M tells if the cancer has spread (metastasized) to distant organs in the body, such as the liver or lungs.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also 2 other values that can be assigned:

• X means the provider does not have enough information to assess the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).

• 0 means no sign of cancer, such as no sign of the primary tumor (T0).

Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer. The stage groupings for the TNM and the ENSAT systems are the same. Each group has a value of 1 to 4, and they're written as Roman numerals I, II, II, and IV. The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

These are the stage groupings of adrenal cancer and what they mean:

Stage I. The tumor is 5 centimeters (cm) or less across and is only inside the adrenal gland. The cancer has not spread to nearby lymph nodes or to organs in other parts of the body.

Stage II. The tumor is more than 5 cm across and is only inside the adrenal gland. The cancer has not spread to nearby lymph nodes or to organs in other parts of the body.

Stage III. In this stage, the tumor has not spread to distant parts of the body, and 1 of the following is true:

• The tumor is no more than 5 cm across and has not grown into tissues outside the adrenal gland, but the cancer has grown into the fat outside the adrenal gland.

• The tumor is more than 5 cm across and has not grown into tissues outside the adrenal gland, but the cancer has spread to nearby lymph nodes.

• The tumor is any size and has grown into the fat outside the adrenal gland. It may or may not have spread to nearby lymph nodes.

• The tumor is any size and has spread to nearby organs, like the kidney, spleen, liver, pancreas, or large blood vessels. It may or may not have spread to nearby lymph nodes.

Stage IV. In this stage, the tumor is any size and may or may not have spread to nearby tissues and lymph nodes. But it has spread to organs farther away, like the lungs or the liver.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.