protocols for follow up testing

adman said:

treatment schedule...
Doesn't seem aggressive enough. Thoughts?

@1 and 6 month: lab of complete metabolic panel (CMP) and no xrays.

@ 1 year: lab of CMP and a chest xray (CXR)

@2 years: CMP and CXR and CT scan

@ 3 years: CMP and CXR

@4 years: CMP and CXR and CT scan

@5 years: CMP and CXR

Radiation
Keep in mind that CT scans expose the patient to a great deal of radiation, which can lead to new problems down the road. I think (and hope) that doctors consider stage and grade when ordering follow-up testing - and weigh the risks and benefits of the various screening techniques. I'm sure cost is also a factor.

Stage 1, Grade 3
6mos. - Blood work, Ultrasound, and Chest x-ray
1 yr. - Blood work, CT scan (chest & abdomen)
After 1 year, if all goes well, most likely blood work, ultrasound + chest x-ray every 6 months.

icemantoo said:

Follow up
As we compare each others follow ups we are comparing apples and oranges or at the very least different kinds of apples and different kinds of oranges. Each doctor has their own tweaks and these change as they see other cases, talk to other doctors, read and take part in studies and still have honest differences amongst themselves. Add to that Insurance and managed care guidelines. If there were not these considerations the nurse could check off your symtoms on a chart and order the tests. While it may be helpful to get an idea about protocol from other members, don't take it as gospel only as general guidelines.



Icemantoo

Follow up
A very useful observation, iceman, that I think we should all try to remember in future.

dl650a said:

follow-ups
In my case, my Doc's protocol (for me) is follow-up chest x-ray and blood work every 6-months for 2 years, then annually until 5 years. In addition there is a CT scan at 2 years and 5 years. My tumor was a T2a and I'm 58 years old.

His comment was that kidney cancers are slow growing and that he feels the radiation exposure from CT scans isn't warranted for regular CT scans.

Everyone's case is individual.

Ed

Protocol
First the good news is that your cancer was caught very early.Probably completely eliminated with surgery. As for exposure from ct scans, I bet I have had at least 15 since last October. Probably another half dozen before the end of the year. I would gladly have settled for only a few. So, I wouldn't be concerned. Wonder what medscanmans take is?

My question about ultra-sound.
After my nephrectomy all I had was semi-annual ultrasounds. I was told that the most likey places to metastisize are the spleen (if I recall), the lungs, perhaps the liver and not the other kidney (thank God).

When the metastisis was found, it was at the very top corner of the ultrasound and they ordered a CT scan to see what it was. They found a lot. I always wondered what would have happened if that lesion was just a little further north.

My concern is, what area does the ultrasound cover? Is it enough?

Digger95 said:

Not sure, Adman...
I had the exact same diagnosis as you (same size and everything) and at the time (July, 2000) my nephrologist told me that it had likely taken two years or more for my tumor to reach that size, and therefore was 'slow growing'. For all I know he could have been talking out his arse, but that's what he told me nonetheless... that RCC is generally slow growing.

Tumour growth rate
We're all amateurs here (a few exceptions like Fox and MedScanMan) so this is just speculation but I think Stage indicates age of tumour and Grade bears more on aggressiveness and hence current rate of growth. Digger's nephrologist was correct in saying that RCC is 'generally slow growing' but as regards his quantification, Digger has accurately identified the orifice from which the pronouncement issued. That's not entirely surprising since nephrologists are specialists on kidneys, not on cancer and RCC will not usually be their focus in the way it is for onco-urologists. Adman's and Diggers tumours probably took around 15 years to reach that size at the typical rate of around 1/3 cm/year. At 9 cm, but of the slower growing chromophobe type (average more like 1/4 cm/year) mine had probably been with me for 30 years or more.

Grade reflects the cellular characteristics (rather than the macro issues of size, location and spread that classify the Stage). A higher grade indicates greater aggressiveness of growth, culminating in the most aggressive, sarcomatoid histology. Since grade tends to change as stage advances, it follows that larger, older tumours will see an accelerating rate of growth. This is of more than pasing interest for some of us and is why I'm having an emergency PET/CT scan in 14 hours time. After maybe 30 years of developing undetected, my primary tumour went from chromophobe to mainly sarcomatoid and put on a great turn of speed. The 2 recurrences I've had, so far, this year, have each gone from a standing start (too small to see) to 2.5 cm in not many weeks. My primary tumour on dx scan was esimated at 8cm and was fully contained. A few weeks later, at nephrectomy, it was 9cm. and had burst out of my kidney (right through Gerota's fascia) at several points, giving me the problems I now have.

So much in RCC is still a work in progress. The estimates of rate of growth are very crude and based on many dodgy assumptions. They're expressed in linear terms but of course tumours are 3-dimensional and, in any case, their characters change with, e.g. vascularisation, calcification and necrosis, to name but a few parameters. Accordingly one can't afford to be dogmatic about these matters but I hope I've given a couple of pointers in roughly the right direction.