The stage of a cancer is how much there is and how far it has spread in your body. Your doctor uses exams and tests to find out the size of the cancer and where it is. Tests can also show 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 it.

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 often used internationally. Both systems are based on the same TNM categories. Ask your doctor 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 large the main (primary) tumor is and how far it has spread into nearby tissue.
• N tells if the tumor has spread to the lymph nodes. If so, where and how many?
• M tells if the cancer has spread (metastasized) to distant parts of 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 two other values that can be assigned:

• X means the doctor doesn't 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).

The T, N, and M values from the TNM system are put together to get the stage grouping. 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 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 other parts of the body.

Stage III. In this stage, the tumor has not spread to distant parts of the body, and one of these 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 spread to nearby lymph nodes.
• 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 the cancer has spread to organs farther away, like the lungs, peritoneum, or the bone.

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