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N, M, Furhman Grading

Bonngo's picture
Bonngo
Posts: 10
Joined: May 2012

Hi Everyone, I am new to this discussion board and wanted to introduce myself to the team. I was diagnosed with renal cancer in December 2011 and underwent an open partial nephrectomy on 1/24/12. Up until now I was so focused on getting through surgery and recovery that I did not join this site (I guess I was probably a bit afraid to know information, if that makes any sense) but am ready to take charge of my health, learn some things along the way and hopefully help others.

I have been trying to understand the grading system and see that T1b was given, but was wondering if I should be concerned that my pathology report could not give me a Fuhrman grade (it said see comments below which I am trying to figure out what they mean) and the N and M descriptions given were "cannot be assessed".

I am due for CT scan and chest x-ray in early August. Are these usually done every 6 months and for how long?

Many thanks!

icemantoo's picture
icemantoo
Posts: 1479
Joined: Jan 2010

Bonngo,

Relax. The Fuhrman scale usually describes more complex tumors. Your pathology of T1b is on the lower end to be concerned with and until and unless any thing else happens you are on your road to a full and complete recovery. CT scans and chest x-rays are done every 6 months for a year or 2 then annually although there is some variance. Often the first follow up is at 3 months. Come join in the discussions. After going thru this you will note that some of us are even able to laugh at our experiences and almost evey one of us are walking around with something less than 2 kidneys. So what, we are doing just fine.

Icemantoo

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I agree with iceman (always a smart move because he's the oracle on this forum) but it would be useful if you could post fuller detail of your path report. The bits you've quoted are intriguing and it would be of interest to know the basis.

Partial, but not laparoscopic - how long was the incision? You're in your prime so you should be pretty fully recovered now and from the follow-up scheduling it seems clear your docs are happy with your present status.

The staging factors N and M which "cannot be assessed" probably reflect there being no reason to suppose you have any lymph nodes affected or any metastases and the wording just indicates caution in not stating unequivocally that you're N0 M0, which you probably are. Pathologists vary in their level of conservatism which is understandable because RCC is so unpredictable (for reasons we're only just beginning to appreciate).

Can you tell us what the 'comments below' were that prevented them from assigning a Fuhrman grade? I doubt whether the grade matters much - if they were happy to do a partial, they must have regarded the grade as fairly innocent.

Finally, can you tell us what size the tumour was?

I second iceman in welcoming you to a very friendly club where we're both sorry that you've had occasion to join us and yet glad that you have.

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Bonngo,

You have already completed the initiation process required to join, we all look forward to the day when this club is no longer needed, in the meantime you will find a good group of knowledgeable and supportive people here willing to help as needed.

In your case no news may truly be good news. Assuming that your tumor was small, your surgeon probably didn't feel the need to remove anything else thus the "cannot be assessed", but this is just a guess on my part. If you could share a bit more information as TW suggests we could be more helpful.

Gary

Bonngo's picture
Bonngo
Posts: 10
Joined: May 2012

Thank you everyone for your warm welcome. I have read through other posts and find you all to be very knowledgable.

In response to Texas_wedge, my incision is about 12 " long and the tumor measured 4.4 x 3.8 x 3.6. I will try to summarize the comment section of my path report.

The tumor ranges from sheets of clear cells to areas with an organoid/nested growth pattern. The tumor cells are negative for P504S and there is no evidence of significant immunoreactivity with CK7. A clear cell carcinoma is favored. The carcinoma is predominantly of low nuclear grade, but areas with enlarged hyperchromatic nuclei (some with nuclear pseudoinclusions) are identified.

CK7 Positive
P504S Negative

Thanks again and I hope you are all doing very well.

Bonnie

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I'm afraid that the data you give are well outside my very modest understanding of this field so to me the histology is opaque and mysterious. Presumably the surgery (very large incision, I would have thought, for a partial) achieved clear margins all round?

Unless there is something anomalous, to me your prognosis sounds excellent, with a small tumour, low stage and low grade and no indication of compromised lymph nodes or suspicion of metastasis. The investigations in August will probably give you an all clear and you can just get on with your life keeping a careful eye open but with nothing to worry much about.

garym's picture
garym
Posts: 1651
Joined: Nov 2009

Hi Bonnie,

Hafta agree with TW, sounds like you should have clear sailing for many, many years. I too am curious about the size of your incision, with partials being done more and more via lap and DaVinci I wondered if there was an underlying reason they did yours open?

Bonngo's picture
Bonngo
Posts: 10
Joined: May 2012

Yes the surgery was pretty invasive with also some section of 12th rib removed. As far as the technique, we tossed back and forth between robotic and open because the Dr. wanted to give me the best chance to salvage some of the right kidney due to my "youth" (ha ha) as I was fortunate enough to have the tumor growing off the bottom of the kidney. The Dr. finally made the decision (with my approval) to do the open approach.

As far as margin, I looked at the path report and it says tumor extends to within .5 cm of the parenchymal margin, so I think that is good?

Well, thanks again for all the great feedback and hope that I can offer back my support to you all.

Bonnie

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