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The Latest on the Vascular Invasion Question

MikeK703's picture
MikeK703
Posts: 235
Joined: Sep 2010

As I posted last week, I sent an email to my urologist about the vascular invasion question that was discussed in an earlier posting. He returned to the office today and got back to me immediately. Kudos to him for that.

Below is his response to my question about vascular invasion and tumor necrosis.

QUOTE
"The prognosis (predictable life expectancy) is primarily dictated by the tumor size (yours was small) and the tumor type (clear cell carcinoma). Secondary factors could be lympho vascular invasion which is that within the tumor the cancer cells were invading into lymphatic channels and vascular spaces. These are POTENTIAL routes of spread but not indicators of definite spread. Tumor necrosis occurs when the cancer cells grow so quickly that they outgrow their blood supply and die to due lack of nutrition. In sum I believe you have a good prognosis with a chance of cancer free survival of >90%."
END QUOTE

I'm not sure I completely understand his second sentence because the way it is worded is somewhat confusing. But I guess this confirms the idea that if vascular invasion is listed as present on the pathology report it can be a negative factor in prognosis. In other words, it's not something to jump up and down with joy about, but it's not necessarily an awful thing unless before the nephrectomy the cancer cells had already spread outside the kidney through the lymph channels and vascular spaces. The >90% survival figure is encouraging to me, though.
Mike

livealive's picture
livealive
Posts: 127
Joined: Feb 2012

GM Mike, I have the same problem, tumor size was 2.5cm per the pathology report, grade 2, but they stated vascular invasion, which is why they put me at stage 3 (pt3a). Prognosis numbers are all over the place - with the max I have heard from the oncologists being 40-50% chance of recurrence, which has had me tied in knots.

I am not trying to dampen your mood, but I have been told by the oncologist at NY Presbytarian that stage trumps size and grade, and stage is determined by factors like invasion. At the same time, other oncologists have put recurrence probability at 10% (same as you) and the nomograms. Various calculators spit out different numbers, but these numbers are meaningless as they do not provide one with where one sits.

The exact problem has come to light here, conflicting opinions and information. Please let me know what your urologist thinks and what he is basing his decision on.

Thanks.

MikeK703's picture
MikeK703
Posts: 235
Joined: Sep 2010

Raj,
I won't be seeing my urologist until September and I won't be asking him further questions about this until then. This is the second time he has answered my questions about vascular space invasion and at some point I have to just take him at his word. He has been consistent in his >90% projection. The way I interpret his answers, from earlier and now, is that cancer cells had invaded the lymph and/or vascular space of the immediate area of the tumor, or perhaps he means the tumor itself, but not in the rest of the kidney. I could be wrong. I think you mentioned "renal vein invasion" in one of your posts. Maybe that's why you're diagnosed as Stage 3 and I am at Stage 1. I don't know if renal vein invasion is the same thing as vascular space invasion or not, but as for me, I'm just going to continue with my follow-ups and see what happens. It is what it is.
Regards,
Mike

MikeK703's picture
MikeK703
Posts: 235
Joined: Sep 2010

Raj, the following info is from cancer.gov:
In Stage I:
the tumor is 7 centimeters or smaller and is found only in the kidney.

In stage III:
-- the tumor is any size and cancer is found only in the kidney and in 1 or more nearby lymph nodes; or
-- cancer is found in the main blood vessels of the kidney or in the layer of fatty tissue around the kidney. Cancer may be found in 1 or more nearby lymph nodes.

"nearby lymph nodes" Don't know if that is the same as vascular invasion. "Main blood vessels of the kidney." Could this be "renal vein" and thus the reason for your Stage III?

My urologist didn't come up with the stage, the pathologist did. So I have to assume that whatever vascular space invasion there was, was limited to the tumor itself. I admit I don't understand it all, but I cannot let it worry me. I wouldn't take any trial drugs to try to prevent spread, I know that. But I am 64 years old. If I was a younger man I probably would be looking into that.

Regards,
Mike

Beingbless
Posts: 46
Joined: Mar 2012

Hi Mike,
Thanks for the update, this is really a good information, evn though I don't understand the last few sentences, but I will take it as postive way.

I am having some trouble with my new anti biotic, lots of side effects, will need to go back to doctor office again. :-(. I feel like I am pretty regular in and out the doctor office lately compare to only 3 times per year prior years....the post surgery really make it so different to my life now. Hope this is something normal.

Enjoy 'warm' Spring!

MikeK703's picture
MikeK703
Posts: 235
Joined: Sep 2010

Hi,
I think the long and short of it is that while you may have had a notation on your pathology report that vascular space invasion was present, this doesn't necessarily mean that the cancer has spread. That's just one of the possible ways it could have spread before surgery. The size of your tumor was around 5 cm if I remember correctly. Your report says Stage 1, right? Although there are no guarantees for anyone, there's nothing better than Stage 1 limited to the kidney, except for a finding of no cancer. So be sure to ask your urologist about the vascular space thing and then just keep up with your follow-ups and pray for the best.
Regards,
Mike

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