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Help understanding the Fuhrman staging!

Jan4you's picture
Jan4you
Posts: 197
Joined: Oct 2013

Need help understanding this staging: Fuhrman grade 2/4. Why is it a 2 AND a 4? What does that mean?

Had radical left nephrectomy, tumor in upper pole between the artery/vein so that is why I needed a radical.

 

Limted to kidney

Renal cell carcinoma, clear cell type

Fuhrman grade 2/4

Lymph-vascular = Not identified

Staging: pTNM pT1a

Lymph nodes pNX

Distant Mets N/A

minimum nephrosclerosis

margins negative

 

Was told Stage 1, and will have a 6 month scan then one more next year. Sounds like that is all the scans unles something develops.

Do you think I should consult an Oncologist or not?

I also have 2 auto immune diseases, would that affect this at all?

 

ANY feedback appreciated,

Jan

 

 

 

 

 

 

 

 

 

 

 

 

 

NanoSecond's picture
NanoSecond
Posts: 532
Joined: Oct 2012

Jan, is it possible it just means 2 out of 4?

My personal feeling is that anyone who has RCC should be under the care of an oncologist regardless of stage or prognosis.

Your having any auto immune disease will likely preclude you from being able to partake in any of the immune-based therapies such as HD-IL2 or anti-PD1, etc.

growler9
Posts: 42
Joined: Oct 2011

Jan - The tumor in my left kidney was graded 2/3 and my right kidney was 2. In my case, the renal vein went into the center of my tumor. It was 6.5 cm and around the vein it graded 3 and on the periphery it graded 2.

The Fuhrman scale doesn't provide for multiple grade tumors so most Pathologists just use the higher grade even though the tumor is not totally that grade. Some Pathologists will make note of differing grades within said tumor.

With a grade 4 you should have scans for atleast 5 years. Ab/pelvic CT and chest X-ray atleast once a year.

Oncologist??? I had bi-lateral RCC stage 3 grade 2/3 and stage 1 grade 2 and don't see the need for an Oncologist. I also have 2 nodules in my left lung I'm watching.

Personal choice I reckon! As long as no red flags pop up, who the heck needs another Doc.

 

Best wishes.  Alan

Jan4you's picture
Jan4you
Posts: 197
Joined: Oct 2013

Thanks NanoSecond and Alan for your responses. But now I must say I am a bit more confused.

For you, Alan, are you saying that with your grading of 2/3 BOTH numbers mean something?

I am surprised you are not seeing an oncologist at all. I am sorry you have tumors in both kidneys.

 

What I was going to do is get a consult with an oncologist for RCC to read my path report and see what he recommends.

You're right about adding another doctor, I have 4-5 specialists I already see. But I just don't want to disregard or dismiss

proper follow up only to find out I waited too long to get help. I am not worried, but want to stay on top of all this.

Thanks again~Best to you both!!

Jan

growler9
Posts: 42
Joined: Oct 2011

Jan - Yes, each grade means something. The grade(s) is/are determined by the appearence of the cells that make up the tumor. The higher the grade the more agressive the cell growth, the more likely it could spread. With 2/4 part of the tumor is made up of grade 2 cells and part of the tumor is made up of grade 4 cells.

Hope this helps. Alan

 

Grade 1 Small, round, dark lymphocyte-like nuclei with without visible nucleoli
Grade 2 Inconspicuous nucleoli, visible only at 200-400X (nuclei usually small and uniform with open, finely granular chromatin)
Grade 3 Prominent nucleoli, easily visible at 100X (nuclei usually mildly to moderately pleomorphic)
Grade 4 Markedly pleomorphic, bizarre nuclei, giant cells, multiple nucleoli
Srashedb
Posts: 191
Joined: Dec 2013

I have never heard of multiple grades; that is interesting. Jan, maybe a visit to smart patients would be worth your while.

Sarah

a_oaklee
Posts: 172
Joined: Nov 2013

Pathologists use different grading systems for different types/locations of cancer.  Sometimes its a 2 level grading system, or 3 levels, or four or higher.  RCC is graded with a 4 level system.  When the pathologist writes 2/4, it means your cells are grade 2 out of  4 possible stages.   

i think it's beneficial to be followed by a renal oncologist Or urologic oncologist with RCC experience.

I should also add that there should be a uniformity with how pathology is reported from doctor to doctor, facility to facility.  As you can see from the different pathology reports shared on this site, some are incredibly detailed and some are entirely lacking pertinent information.  I've seen the same thing with  CT scan results.  We had one with no measurements reported and our doctor requested a more detailed report.  

Regarding the grade, the higher the number, the more abnormal the cells are from normal Cells.  

twinthings's picture
twinthings
Posts: 403
Joined: Jun 2013

Hi Jan,

I hope you've found the clarity you were looking for in terms of the grade of your tumor. 

You are not alone in your confusion regarding whether or not to seek the care of an oncologist.  I too, wondered if I would benefit from seeing an oncologist and I can happily say, I certainly have. 

In my case, my urologist discouraged me from seeing anyone but him for atleast the first 2 years post surgery.  According to him, the standard of care for my stage 1, grade 2 Clear Cell RCC, is a chest x-ray every 6 months.  Personally, that wasn't good enough.  I have good insurance, why am I not getting good care?  At any rate, I had my standard chest x-ray at 6 months.  Nothing remarkable.  The week after having that x-ray, I had my first appointment with my new oncologist.  That very day, he sent me for a chest/abdomen/pelvis ct (w/o contrast).  That ct showed a 1.5cm growth in my tummy, near my spleen.  It also indicated I have a swollen mediastinal lymph node (I think that node is either in the lungs or between the lungs).  So, doctor had me repeat the ct at 3 months.  The node grew from 0.9cm to 1.3cm.  The growth in my belly had no change, however I do have a 6.5cm dehiscence at the site of my incision that will likey need to be repaired.  I meet with my general surgeon in May.  So, am I happy I sought the care of an oncologist?  You bet I am.  Now, I truly feel like I am being as proactive as I can possibly be, concerning my healthcare. 

It took me a while to find a doctor because most that I called wanted patients with active cancer.  Since I had mine removed, technically I'm not a cancer patient.  But, I kept at it and it paid off.  Granted, my onc is not an RCC specialist but he's better than the ones who wouldn't give me the time of day!!  God forbid I have mets down the road, I will find someone who specializes in RCC...that should qualify me for their care!

@Nano, I did not know having an autoimmune disease would disqualify someone from being on trial drugs.  That's interesting and good to know.  Let's hope I never need those drugs.

Good luck, Jan.  For what it's worth, the piece of mind I have from seeing an oncologist is worth every bit of the hassle it was to find him.  Think about it.  So worth it!!

Sindy 

NanoSecond's picture
NanoSecond
Posts: 532
Joined: Oct 2012

No, only immune therapy clinical trials, Sindy.  Not all clinical trials are immune therapies.  You would presumably not be excluded from any of those that do no rely on the immune system.

Of course, always check the fine print for the inclusion and exclusion criteria.

twinthings's picture
twinthings
Posts: 403
Joined: Jun 2013

Ahhh, good to know.  Thanks for clarifying that for me.  I hope to never need to learn more on the topic of clinical trials. 

And by the way, you may be happy to know, I have significantly cut back on sweets, thanks to the helpful info you gave me a while back.  I still have a mad sweettooth, I just no longer indulge it like I did prior to learning the connection between sugar and cancer.  So, thank you!! 

NanoSecond's picture
NanoSecond
Posts: 532
Joined: Oct 2012

Sindy, that is wonderful news indeed. 

It takes time to overcome a sugar addition (and yes, it is definitely addictive) so please hang in there.  It is well worth it.  In time you may be amazed by how much better you start to feel.

Jan4you's picture
Jan4you
Posts: 197
Joined: Oct 2013

Thank you all for your help. I am still uncertain ( and now confused) regarding the Fuhrman 2/4 meaning so I just make an appointment with an Oncologist who sees RCC patients too. He is next door to the Urologist/Surgeon and my primary and connected via same health program so he can view my scans, Path reports etc.

Sindy always good to hear from you as well. I too will ask how auto immune diseases affect treatment if it is necessary.

I also have a rare kidney disorder called Gitelman's so my remaining kidney is slightly compromised.

I just want to follow up on this "spiritual hunch" I was getting and find out what the oncologists recommendations will be for the future. Ironically, the lady who scheduled the appt was surprised I was not referred to an oncologist in the first place, but I could tell she didn't know that much about RCC. She was going to get me in this Thursday as Oncologist will be going on Jury duty. But I now have an appt for the 24th.

Get this, she even said to call ahead and she can tell how behind in time he'll be so I don't have to wait that long. NEVER had anyone of all the docs I've seen do that..amazing as I am onl about 7 mins away.

Thank you all, shows how confusing reports can be, right?

Jan

 

Srashedb
Posts: 191
Joined: Dec 2013

jan:

great to hear that you are seeing an oncologist and getting some answers to the complicated report.

sarah

todd121
Posts: 598
Joined: Dec 2012

The urologists don't know squat about metastatic RCC. They don't treat it, and don't follow the field that closely. A knowledgable medical oncologist will know how to really follow you for metastatic RCC. For instance, most urologists will order an X-ray of the lungs and not a CT-scan, but we've heard cases of things being missed by an X-ray. Try to get someone with some RCC experience, (the best is someone who is an RCC specialist, but they are far and few between). At least find someone willing to read up on it and call/consult a specialist as needed.

In my experience, my urologist (who is an excellent surgeon, btw, and a really qualified one) told me I was cured and my prognosis was great. He wanted to do a chest X-ray and CT of abdomen and pelvis after 5-6 months (which is the minimum standard of care). I had a known spot on my femur. He didn't think it needed looking at. I went first to a medical oncologist with no RCC experience. He told me a little less rosy picture, of about a 10% chance of recurrence, but wanted to do a PET scan of the spot on my femur (at least he wanted to follow up on it) and he wanted a CT-scan of my chest. However, I consulted with my uncle, a medical oncologist with 30 years of experience who told me that I needed to see someone else, that this medical oncologist wasn't quite up on things. So he was better, but still not up to par. Then I saw 2 RCC specialists. These are guys that do research on kidney cancer and see kidney cancer patients many times a week. They independently told me my prognosis is about a 40-50% chance of recurrence. One of them actually pulled up the study that was done at UCLA to prove to me what he was saying had data behind it. He wanted a CT of my chest, abdomen and pelvis for follow up after 4 months. Regarding the spot on my femure, he had the radiologists at the cancer center look at the CT (they see a lot of cancer) and they said it was probably no cancer. Just to make sure he ordered a nuclear bone scan, which evidently is the correct test for spotting RCC on bone, and not a PET scan.

I feel much better being followed by docs that really know RCC and since there are several within 1-2 hours drive, I decided to do that. My urologist did a great job and I'm thankful to him. But if my cancer returns, I want a different specialist involved. The one that will be responsible to take care of the problem. I'm an engineer, and I've always found that people do a better job when they are invested in the result and not just going to pass the problem on to someone else.

Best of luck to you.

Todd

Jojo61's picture
Jojo61
Posts: 388
Joined: Oct 2013

Jan, when I went for my scan results today the doctor reviewed the path report. On there it said my grade was 2/4 (he said 2 out of 4 and that was good). I immediately thought of you. Smile

Hope this helps you a bit.

Hugs,

Jojo

Jan4you's picture
Jan4you
Posts: 197
Joined: Oct 2013

Well how timely~~thanks for finding this out and sharing!

Glad you got the All Clear~

Jan

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