Is there a general consensus of RCC growth rate?

There is no consensus
There is no consensus.

On line, I have seen rates advertised at 1 cm/year.

However, talking to researchers at NIH, I am told it can be 1 mm/year, which approaches no growth, or several cm/year, with aggressive cancers.

Medical science does not know the answer. And the rates may not be constant for a person over time.

I am trying to dig up older scans from nearby regions to assess the growth rate of my tumor. From what I can tell, in 1992, there was no evidence of disease on a CT scan.

In 2003, I had a liver ultrasound, which should have seen the kidney, but they did not see anything. In 2012, I had a 6 cm tumor identified. Based on that, my tumor grew 5-6 cm in 9 years, or no more than .5 cm/year.

But, we do not know.

dhs1963 said:

There is no consensus
There is no consensus.

On line, I have seen rates advertised at 1 cm/year.

However, talking to researchers at NIH, I am told it can be 1 mm/year, which approaches no growth, or several cm/year, with aggressive cancers.

Medical science does not know the answer. And the rates may not be constant for a person over time.

I am trying to dig up older scans from nearby regions to assess the growth rate of my tumor. From what I can tell, in 1992, there was no evidence of disease on a CT scan.

In 2003, I had a liver ultrasound, which should have seen the kidney, but they did not see anything. In 2012, I had a 6 cm tumor identified. Based on that, my tumor grew 5-6 cm in 9 years, or no more than .5 cm/year.

But, we do not know.

Consensus?
I think that in reality there is a consensus. A lot of different figures have been put out but they usually derive from, or relate to, particular contexts or sub-sets of patients. Over the past few months, on various threads, I've quoted from published expert papers on the subject and given refs. for some of these. It's established that an average growth rate, across the board, ia around 1/3 cm/year but slower with more indolent tumours such as chromophobe ones which are more typically 1/4 cm/year.

However, there is a very wide spectrum and, as dhs saya, it's different with more aggressive cancers and, without doubt, changes over time in the very same patient - my own case illustrates that as graphically as one could wish (or as, personally, I could wish it didn't!).

Angie rightly surmises that it might be contingent on grade and asks if anyone has first hand experience - my first-hand experience is all too real and is as fresh as about 3 hours old. I'm about to give a bit of detail on another thread.

At one end there's very aggressive growth - sometimes so fast as to encompass (partial)death of the tumour as its growth rate outstrips its angiogenic capacity and results in necrosis. At the other end, there's 'negative growth' i.e. shrinkage, which may be consequent upon successful treatment, or spontaneous, deriving from the body's successful immune system activity or from apoptosis in the mutant cells instead of the feared immortality. Our bodies constantly head off cancerous prospects and, usually, thereby keep us safe from this malaise. So,in innumerable cases there is no growth or negative growth but at times some of us aren't so lucky.

angec said:

TW..as always your input is
TW..as always your input is very well respected! I am hoping this is a great week of golf for you, as Mashall. I await your new post. Prayers and well wishes and thoughts going out to you. Please continue your very positive attitude and know we all love you!!

Estimates of tumor growth rate

Since this topic seems to exhibit recurrence, I thought it's worth mentioning that at the European Urology Association's 28th Congress, which finished 2 days ago, one presentation alluded to this matter and a slide (I've not seen the relevant text) refers to observation of a few hundred small tumors.  It talks of a mean size of 2.8 cm and a mean growth rate of 0.28 cm/year.  The nature of the tumors is unclear from the slide but it appears to show that for RCC the figure for 120 RCC instances was 0.40 cm/year.  This accords pretty accurately with the study by Bosniak et al  many years ago suggesting a mean growth rate of around 1/3 cm/year (and more like 1/4 cm/year for (non-sarcomatoid) chromophobe.

dhs1963 said:

Growth rates vary.

A 100% clearcell will grow slowly, at .2-.5 cm/yr, acording to my Dr at NIH.  That is what allows the conservative approach many doctors take.  Under Grade 1, a 2 cm tumor will not be dangerous for many years.

The difference comes with the higher grade tumors.  Clear Cell with Sarcomitoid features can grow at rates exceeding 1 cm / year.  In my case, there is evidence that my 6 cm tumor DX'd in 2012 did not exist in 2005 (when I had an untrasound of the liver).  The lung met I had, also sRCC, had grown from undetectable to 1.5 cm in 6 months, suggesting a 3 cm/yr growth rate for the met.

That means that RCC can go from low risk to extremely dangerous with no radiological difference. 

Anther way to put it is, a 80 yo person with a 2 cm tumor that is not aggressive probably has 10 years before the tumor goes from T1a to T1b.  In that case, surgery may not be warneted.

But, if it is agressive, in two years the tumor can grow to 6 cm, and metastisize. That is probably what happened to me. 

Growth rates vary

Yes, indeed - you're echoing what I've said on this forum many times, so just a few additional points.  The very aggressive tumors are the sarcomatoid ones and they are the larger ones. With some exceptions, notably those detected in the young (and more often hereditary than others) small tumors aren't, generally,  aggressive.

I'm not sure I understand what you mean when you say "That means that RCC can go from low risk to extremely dangerous with no radiological difference."  

I think you've made an invalid jump in your last paragraph, haven't you? You're projecting the growth of a primary tumor on the basis of the growth rate seen in your lung met.  It's important to realise that the growth rate of mets is a different story entirely, especially when they are part/all sarcomatoid from inception. There, your own rate of met growth is unsurprising pro-rated to 3 cm/year, from having gone from undetectable to 1.5 cm in 6 months. My first renal fossa recurrence grew by a lot more than that in 4 weeks and the ab wall tumor that I have now grew from 2.5 cm to 5 cm in 23 days which if the growth were linear would equate to almost 40 cm/year and would have already got to 25 cm by now.

Growth Rate

My urologic oncologist said that RCC tumors grow between 0.3 and 0.9 cm per year on average. I didn't ask more detailed questions about what the assusmptions were or where he got this information. I had assumed he was talking about my situation at the time, which was assumed Stage 1 (under 7 cm) tumor hopefully Grade 1 clear cell RCC.

The situation we were discussing was about the "active surveillance" approach to small tumors.

In fact, I had a look at his website just now, and he did say "Studies have demonstrated that small renal masses tend to grow at a rate of 0.1 to 0.8 cm per year." There may be links on his website to help investigate this. www.kidneycancerinstitute.com. I believe this particular quote was more generic (small renal masses) and not RCC specific.

I'm not sure that averages will help you answer your question. This does seem to be in line with what you said above (1/2 cm per year). Did you mean 1cm instead of 1mm?

Todd

 

 

Texas_wedge said:

Growth rate

Todd, I hope you'll keep referring people toLandman's site - I've not done so for a long time and it is a cracking site, especially re up-to-date information on minimally invasive procedures and on active surveillance and with good videos thrown in.  It would be hard to find better information on those topics, although there are bound to be some generalisations that one might dispute , e.g. "Today, the majority of kidney cancers are discovered while very small".  Tell that to the increasing number of younger patients we see here who have tumors discovered early in life but not exactly "very small"  e.g. > 20 cm. !!!!  Daisy is our latest in that group and she should be cheered by how wonderfully Chris Boone has done.

Perhaps we can agree a summary on this topic, as at the present time?  Several members have quoted their individual doctors' anecdotal comments, while I've cited the actual major studies on the subject in papers which give real figures from studies researchers have made of numbers of patients.  Among all of the data we've accumulated, there isn't any fundamental dissension from the following, I believe:

• RCC tumors grow at widely varying rates but on average at around 0.3 to 0.4 cm/yr - shown by academic studies
• chromophobe RCC typically grows at the slowest rate
• sarcomatoid de-differentiation betokens much greater aggressiveness and much faster growth
• growth rate of mets is very different from primaries - e.g.  the second met which I currently have was growing, before I started on Votrient, at 100 x the average growth rate of a primary RCC tumor
• the usual caveat applies about the inapplicability of group averages to individual cases

 

Met Growth Rate

Tex,

On your 4th bullet point - about the higher growth rate of mets - can you cite any formal studies that might help illuminate that one?

Texas_wedge said:

Met Growth Rate

No, Neil, I'm afraid not but there are possible reasons why that is a questionable question. 

(By the way, I think there's constant case by case anecdotal evidence of the truth of the statement - a rich field is to be found in the frequency with which mets not perceptible at nephrectomy appear at significant size not much later, particularly, of course, if the histology is a very aggressive one - I think my own case is just an especially dramatic example).

Now, why do I say it's a questionable question?  On the 'seed and soil' nature of RCC spread, much must surely depend on the nature of the site of the met, as well as the aggressiveness of the pathology and quite possibly on the modality of spread.  There are doubtless a lot of other relevant factors that contribute to the overall scenario in which there are many more parameters affecting RCC met growth rates than apply to RCC when it's "at home".  D you agree?

By the way, you and I are ships that pass in the night on various sites at present, as well as email.  I owe you a number of replies and also thanks for your thoughtful last email.  You've dropped so much intriguing material in my lap and I'm snowed under with commitments at present so please accept this marker as a proxy for proper replies, pending time to do justice to your posts and links.

While 'speaking' I want to pursue one or two thoughts.   (Just been interrupted by a call from SIL in Fairfield CT so some thoughts have fled.) Theme was personal comparisons, since we both have chRCC although, thankfully, yours isn't sarcomatoid.  I imagine we have similar builds - I've shrunk from 5' 9 1/2"  to about 5' 8" and have lately lost about 8 lb to around 146.  I'm guessing you at about 6' 1" and 170-175 or so.  Am I anywhere close?  I'm a 'universal donor' - i.e. Blood type O and Rhesus negative.  What are you?  I tend to have a high metabolic rate a lot of the time, due to a fair amount of exercise, though dismally little for the past fortnight

Comparing Notes

Trevor,

No rush on responding.  Those papers are a bit formidable - but I do think they may have some very useful insights for you.

I am 5' 8" and weigh around 142 lbs.  So we are much closer than you guessed.  I am aiming (very slowly) to get to 140 lbs.  Before I started on my diet (back in August) I was at 162 lbs. I am blood type A Positive.

I presently feel great - the best I have in decades (isn't that perfectly ridiculous?) which I am convinced is a by-product of my diet and supplements.

The key area I am still deficient in is getting more exercise.  I do make it a point to walk briskly at least 1 hour everyday.  And the path I take goes up and down a few steep slopes.  But that is about it.

 

Texas_wedge said:

Comparing notes

I'm sure you're right about the academic papers Neil. 

Several other good talking points here and, before I forget, may I commend you on your walking schedule which is good enough to guarantee considerable benefits.  I'm not in the slightest surprised that you feel better than for a long time and I'm sure you'll have noticed plenty of others saying much the same thing (Todd is likely one such).  I have no doubt that getting rid of the cancer is a factor (!) and I'm equally sure that the exercise is another contributor, if it's something that you weren't doing before.

I've imagined you to be the archetypal lean cerebral academic type and so I was surprised to learn that you were, presumably, carrying some bad weight which you're now happy to be rid of.  Why is 140 lbs your target? You could carry more at our height  with more muscle mass, which is invariably a good idea for almost everyone.

You're right that my guess at our similarity of build is closer than I even guessed! The similarity disappears at some points though. 

I've thrived on heavy exercise all my life and a variety of sports - can't tell you how much better it makes me feel than when I'm less active (like now - but, at least, due to play golf on Friday, if the snow has thawed by then). 

Also, Ive been interested in and fairly sensible about diet for most of my life, in respect of athletic performance, health (never a problem for me until cancer dx at 69) and in the intriguing domains of allergy, food sensitivity and possible implications in various areas of mental health (and physical too, of course) and quality of life.  Perhaps, as a result and maybe a favourable genetic legacy, I may have had less scope for improvement of diet with the resultant benefits.

I asked about blood type.  There, we couldn't conceivably be much more different - you A +ve and me O -ve.  I think more exploration in this area is essential.  We know a bit about the clear relations between different prevalences of RCC sub-types according to gender and to race, to name but two relevant parameters and I'm fascinated to know whether blood-type is another significant variable. 

A little while ago, on the thread entitled "Opinions on High Protein Diets" I responded to a post by Gail (who hasn't pursued it further because these days she spends most of her posting time on KIDNEY_ONC and elsewhere) by saying this:

Diet and blood type

Gail, it's several years since I was reading D'adamo but his theory struck me (after initially thinking it the work of a crank) as inherently highly plausible. For most of my life I've been fascinated by the complexity of the human body and the ramifications of the biochemical individuality that is so evident. I was intrigued by some of the work of an early luminary in the immunology field - Arthur Coca.

Anyway, on first encountering D'adamo's books, I figured that it would be surprising if our blood type did not interact with the chemistry of what we ingest. After all, differences in blood chemistry are hugely important. For instance, I am a 'universal donor' which makes my blood particularly valuable socially (apart from being fairly important to me!). When I go under the knife on 30th March, it will be crucial to have blood of only my type available for any transfusions I may need because if I were given blood of any other group it would almost certainly kill me. The other obvious example is the Rhesus Factor - blue babies and so on.

I must revisit D'adamo. Your posting led me to look at a site by some enthusiast in New Zealand which contains an (unattributed) table which suggests that with my blood type I would have a tough digestive tract, strong immune system and a predilection for intense exercise, all of which is spot on. The rest of it I'm not as sure about. It also led me on to, ultimately The Weston A. Price Foundation which sounds like a collection of dangerous lunatics. They seem to have totally conflicting policies but appear keen to promote eating as much saturated animal fats as you can. They also advocate reducing your phytic acid intake by all means possible as being a dangerous anti-nutrient. Interestingly, this is another name for IP6, the anti-cancer and numerous other benefits of which I have just been exploring as a result of Olsera's question on the thread "are natural remedies snake oil or promising?"

I wonder if you've speculated on such matters at any time, Neil?  I'd welcome your thoughts.  I'll seek to vindicate this enquiry in the following way:

It seems to me to be a perpetual necessity to rigidly separate observation of phenomena from proffered explanatory apparatuses. To take an ad absurdum example - if a particular homeopathic 'remedy' were observed to incontrovertibly confer some benefit (even one unrelated to its purported function) then it would be plainly unscientific to pooh-pooh it simply on the grounds that the only explanation of its efficacy is one that we find completely implausible.  It may be that there are flights of fancy pleaded in the cause of explicating observed relationships between blood type and incidence of particular ailments such as CVD but we shouldn't disregard the evidence for that reason. It's by scrutinising novel off-the-wall ideas that many advances of knowledge come into being.

 

Blood Type and Weston Price

Hi Trevor,

As always with your posts - much food for thought (pun absolutely intended).

First off - at this point I have zero knowledge about blood type, etc.  But you have put it on my radar and so I will try to be vigilent.  Unfortunately, I have so much else cluttering that little radar screen that I am afraid there is going to be an air-traffic control accident pretty soon.  So, in the meantime, please do elucidate more about what you know concerning this subject when you have a chance.

But about Weston A. Price I do know some things. As an organization you may be correct in its having an agenda to promote eating animal fats.  I seem to remember that it was once accused of just being a front for the cattle and dairy agribusiness interests.  I don't know if that is true or not.  However, I have found that a few of its accolytes actually do know quite a lot about cell metabolism and other matters of keen interest.  So which particular lunatic did you have in mind? 

Have you ever read "The Daily Lipid" blog by Chris Masterjohn?  He really seems to know his stuff.

I am not sure about the other Weston Price apologists - but I do know that there are a lot of "paleo" followers who seem to get great comfort from some of his (Weston's) early research.

Of course it is important to make a distinction about diets that may work "well" for otherwise "healthy" people and those who might be suffering from cancer or the threat of metastases.

For me the answer is just to delve deeply into the mechanics of cell metabolism.  And, in particular, the role(s) played by glucose, fatty acids, insulin, ATP, etc. in supplying energy to the cell.  That has led me to investigate the cell mitochondria in particular.  So I was stunned when I came across the magnificent work of Dr. Terry Wahls - as she had figured all this out and actually then applied her medical and scientific skills to remedy her own issues fighting MS. 

In the course of my research I have come to question all sorts of "dogmas" regarding saturated and poly un-saturated fats or just how "harmful" animal vs. plant protein might be.  And those are just for starters.

So, while I am aware of the various agendas that may be out there - I tend to dismiss the "organizations" and focus on those individuals who really seem to know what they are talking about.  Meanwhile I am such a neophyte I have such a long ways to go.  I can only point out, for example, that I have learned a whole lot more from reading Denise Minger's well reasoned criticisms of "The China Study" than I ever did from the original book itself.  And so it goes...