Post Radical Nephrectomy Update

LolliG · March 2022

Hi All. I don’t know if I’m writing in the correct place, I wanted to continue in my previous topic but couldn’t see how to do that. I don’t know if there’s a way to link this new thread to the previous conversation I started at the beginning of the month. Anyway.

First I want to thank everyone for the advice they gave, all of which turned out to be sooo helpful. e.g., pillows in the car on the way back from hospital, getting started walking asap… these things made all the difference.

My hubbie had radical nephrectomy two weeks ago. He is doing so well, thanks to the great advice given. He left hospital two days later and immediately began walking, even during the first day and night at home, albeit slowly. Gradually he has added a few kilometers of walking each day, and today he started gentle jogging (he is a marathon runner so is keen to get back to it). He was working again the same week that he left hospital (remotely from home) and on Monday he returned to the office (desk job so that makes it easier).

We just got the histology results, as follows: 36 x 38mm tumour, RCC chromophobe subtype and Nuclear Grade of 2 - 4 including a component of multinucleated tumour giant cells. Stage 1 - pT1a. No evidence of sarcomatoid transformation. The doc said that the prognosis is “excellent….”

Docs report also says Post op eGFR is 52 (Pre op was 84). Is that bad?

… I have some questions please if anyone can help:

Is it normal to be Grade 2 - 4? How can it be more than one grade? And Grade 4 sounds very serious… does this high grade have implications for possible future recurrence or anything else? What does “Giant cells” mean? What does chromophobe mean?

The recommended follow up is chest CT every 6 months for 3 years and then yearly until 10 years, and Abdo CT yearly for 2 years and then every 2 years until 10 years. Do you think that sounds okay? They have also suggested a head-to-toe PET CT scan at 3 months to check entire body, because of having two entirely unrelated cancers in such a short time (low grade liposarcoma in back was removed 3 weeks before the nephrectomy). They also want to do genetic testing.

Any thoughts would be appreciated, as this is all new to us and a little overwhelming. Thank you.

Bay Area Guy · March 2022

Chromophobe is generally considered to be the least worrisome of RCC’s. My docs said it rarely recurs and it rarely spreads. I had a partial (chromophobe) and it was 6 month scans for the first year, then annual to my 4th anniversary. I was referred to a survivorship program after that and asked for and got permission from the insurance company to continue on with an annual chest x-ray and ultrasound. Your insurance may balk at ten years, but if they pay, I’d get the scans. And if they don’t and you can afford it, I’d continue with ultrasounds, but I’m a little paranoid. As for the full body scan, my only concern would be that, in combination with the CT at six months, is that too much radiation exposure?

Glad to hear he’s doing well.

AliceB1950 · March 2022

It's grade 2 out of 4, not two different grades. Grade 2 is very good! Mine was grade 4 so I got more frequent scans the first few years. Your husband's cancer is about as good as it can get for a cancer.

LolliG · April 2022

https://csn.cancer.org/discussion/comment/1695507#Comment_1695507

Thanks so much @Bay Area Guy and that’s a good point about radiation will check it out.

LolliG · April 2022

https://csn.cancer.org/discussion/comment/1695513#Comment_1695513

Thank you @AliceB1950 The doc said the tumour grade covered the range of 2, 3 & 4, I hadn’t heard of that before as everyone else seems to have just one grade. But wonder if different parts of the tumour were different grades. It’s encouraging to hear that you are several years out after grade 4! Hope that continues well for you.