The ENSAT stages (European Network for the Study of Adrenal Tumors) describe the spread of adrenocortical carcinoma (ACC) and represent an internationally used classification. They are based on tumor size, lymph node involvement, and distant metastasis – similar to the TNM system.

ENSAT stages in adrenocortical carcinoma

Stage

Description

Stage I

Tumor ≤ 5 cm without infiltration of neighboring structures and no lymph node metastases or distant metastases (T1, N0, M0)

Stage II

Tumor > 5 cm without infiltration into neighboring structures, no lymph node metastases or distant metastases (T2, N0, M0)

Stage III

Any tumor size with local infiltration (T3/T4) and/or regional lymph node metastases, but no distant metastases (T3/4, N0/1, M0)

Stage IV

Distant metastases present, regardless of tumor size or lymph node status (M1)