Stage vs Grade?

Dawg8037

Hello everyone, I just came across this message board, what an awesome resource. My story, like most, begins with an incidental finding during an MRI for an issue with a pinched nerve in my lower back. I was soon referred to a urologist and a CT scan confirmed the MRI....a suspected 3.5 cm RCC tumor on my left kidney. 4 weeks ago I had it removed via robotic partial nephrectomy, one night stay in the hospital. Recovery has gone well, I returned to work 2 weeks after surgery. The pathology report listed it as Stage T1a clear cell RCC, ISUP/WHO Grade 4 with < 5% sarcomatoid features. At my follow-up with my urologist, I mentioned my concern about the grade....and whether it meant I should consider myself higher risk. He reassured me that my prognosis was positive, as it was all removed and had clear margins. He said that from here forward, I am just in a surveillance protocol to monitor any recurrence. So my question is, what has the greater effect on prognosis, stage or grade? I feel good that I am (was) Stage 1, but where should my concern be that my tumor was Grade 4, even though less than 5% of it was sarcoma? Has anyone had this odd combination of low stage yet high grade? I appreciate y'all chiming in!

rcole

not sure about grade but i had my left kidney removed 2 years ago my surgery didnt go as well as yours my doctor droped "some cancer in to my stomach" im stage 4 now and it spend to my liver i was in the hospital for a week partly because of my blood sugar was out of wack sounds like you have nothing to worry about you should check out the CSN Chatroom a lot of good people there

key2025

Hello Dawg8037, for renal cancers stage is substantially more prognostic than grade, but grade is typically predictive/correlated with stage. Stage is an indication of the size and spread of your tumor (localized/regional/distant) while grade is a pathologists call on how much your cancer cells look like normal cells. The more dedifferentiated or dividing your cells look (stage 4 is the highest call) the more the tumor is thought be aggressive or likely to grow quickly. An issue here is that grade doesn't have a set rule regarding what % of cells. Pathologists will assign a tumor a grade based the highest grade even if they are only a small fraction of the tumor (like in your case).

As an aside, the numbers associated with grade are not consistent between cancer types as sometimes grade 0 is the most aggressive while grade 4 is. The ordering of stage is consistent but the criteria for them differs between cancer types.

We also don't have an accurate understanding of why some tumors metastasize and others don't. It has been observed that renal cancers typically seed metastases very early on based on anecdotal cases of organ donors from renal cancer patients. Recipients that go on immunosupressive were noted to have renal mets derived from the donor organs.

If it would be greatly helpful for your peace of mind, I can try and dig regarding the fraction of patients with low stage but high grade. The US has the gold standard of cancer statistics via the SEER program and that information will be in there (but it is not the most easy to access and is restricted). Upfront I would expect only a small fraction of cases to fall in your category so any numbers may not be statistically significant.

Rcole, praying for you.

AliceB1950

Mine was also grade 4, due to rhabdoid features - no percentage was given - and unclassified type. It was stage 1b, right at the 7 cm cutoff between stage 1 and 2. My surgery was in 2018, and the urologist had me get more frequent scans the first three years, plus I will continue with annual scans for another few years, then move to every other year if all scan results are good. Over the last five years, I've tried to find information on stage 1 grade 4 percent of recurrence, and there is shockingly little information available. Either we are unicorns, or our risk is low enough to be uninteresting to medical research.

ckauf1969

Mine was found incidentally as well in 2015 due to appendicitis flare up. They found my appendix burst and during the scan to find out where my pain was coming from they found my right kidney was enveloped with cancer. It was stage 3 due to size , 7 cm. They took it out and had scans every 2 months for 2 years and then 2 times a year after that. I was good until 2018 they found metastasis to my lungs. Do I am now 6 years from metastasis diagnosis, I’ve had 10 radiation treatments and take Inlyta chemotherapy pills twice daily and have Keytruda immunotherapy treatments every 3 weeks. Been doing okay except last scan showed moderate spread. I have 10 tumors throughout both lungs ranging in size from 2 mm to 4 cm. Recently I am very tired all the time and sleep a lot with depression. I have a PET scan next week to find out exactly where I’m at and if I can have radiation or surgery to remove any tumors.

ckauf1969

I kinda figured out that depending on where the cancer was located on the kidney reflects greatly on percentage of metastasis. If the cancer is on the outside of the kidney and not invading the inside then the percentage of metastasis is lower than if the kidney is enveloped with cancer, then the cells have a better chance to get in the lymphatic system and into the blood which causes the metastasis to other parts of the body. Just my 2 cents.

AliceB1950

https://csn.cancer.org/discussion/comment/1713528#Comment_1713528

If the cancer is all through the kidney, it would automatically be a stage 3. Further scanning would be done to determine any metastatic spread. In a simplified nutshell, Stages 1 and 2 are based on size, 3 is based on invasiveness, and 4 is based on spread beyond the kidney area.

ckauf1969

Thanks for the information.

Dawg8037

I appreciate everyone's replies. We all have our individual stories to tell, but have fear and anxiety in common. While my prognosis seems to be very favorable according to my urologist, I still have some fear of spread that hasn't reared its ugly head or a recurrence somewhere down the road. I know only prayer and time will tell. I've been living life as normal as I can....in fact, most times I "forget" that I had/have cancer. Then there are those little whispers in your subconscious, reminding you that you are going through this, and very well may not be out of the woods just yet. How have y'all silenced the small doubts and fears that remain? Does it ever go away? I want to live without this little dark cloud following me, just a few steps behind.

Allochka

Hello,

Unfortunately, higher grade will definitely screw with your mind, making you more nervous. But in reality it doesn't mean the cancer will return. It does make a risk a bit higher, but this is just statistics.

You could check out Leibovich risk scoring system for kidney cancer, where each tumor characteristics gives you certain points to evaluate the risk. Then you sum them up. But anyway it is just statistics, not you. However you should discuss a more vigilant follow up just in case

In my experience, a cloud does go away in 2-3 years and returns only prior to scans for a short period.

Stay tuned, this is a very helpful community and lots of positive stories here!