New here

Well Welcome to our forum! I assume your name is John, right?

I cannot answer most of your questions, except to say ASK your surgeon/urologist.

Some of your questions need to be well understood and seems important to you so ask your MD.

Maybe others will make a stab but again, we're not the doctors.

You are lucky as i was. Had the same size tumor , yet had to have kidney removed.

Did you mean your surgery was a RADICAL nephrectomy?

Follow the protocol of being monitored, ask your doc those questions and like me be blessed they caught it so early.

Warmly, Jan

hardo718 said:

Welcome John

I wish I would have known of this site long before I found it too.   I was 3+ years post-op.

Stage 1...... AWESOME!!  As far as how long it was there, how fast it grew, my doc couldn't give specifics other than they are typically slow growers, but ask yours anyway.  And regarding another question, unifocal generally means in one location.  But as others have said, you're better off directing your questions about the other specifics to your doctor. 

Sounds like you're recovering very well. 

Donna~

 

 

and you will find most of the primary answers on sites that list "Staging Kidney Cancer", and Complete Blood Screen or Complete Metabolic Panel.

Stage I-Greaaaaat.  Under 7 cm and confined to one area.  Not metastasized.  eGFR is related to age and 1 or both kidneys.  For my age, if I had both kidneys a 60 would be excellent.  With 1 kidney, it runs between 37-43.  You will find that is correlated with creatinine (or protein) in the urine.  If one goes up/the other is down a hair; and vice-versa.  The dr's or onc. will watch it and see where you stabilize or what your range is for the 1st year or two.  Your new NORMAL.  Just make sure you have adequate hydration to keep the kidney flushed.  And if you are having fasting blood work, make sure you drink water when you get up-it does make a difference.

You know how turtles go...sometimes not at all, but every once in a while they take off.  That's cancer.

Welcome to becoming a cancer survivor, and just keep on getting your check ups.

donna_lee

donna_lee said:

Oops, forgot about the HBP meds

Your regular PC/internist should be managing those for you.  The one thing is that you will probably need something for BP to avoid further damage to the one kidney.  Ace inhibitors, Beta Blockers, and diuretics all do different things. I have been on Lisinopril and Metoprolol for years-well since Kidney cancer.  After a weight loss a couple of years ago my lisinopril was lowered from 10 to 5 and then to 2.5 mg. Metoprolol is cut in half so I take 12.5 mg.  Taken daily at night, when I does the most good.

donna_lee

Welcome, John! glad you found us, but sorry about the circumstances.

It sounds like you are in a good place with your diagnosis. Yes, drink plenty of water. Also, stay away from Advil. If need be, use tylenol. And follow up with your BP meds. My pressure dropped quite a bit after the nephrectomy. I still need the meds, though - just the dosage was cut in half. Now as far as the cancer's speed of growth....it is a guessing game really....I was a stage 3, and had a 13cm tumor and the doctor thought I had it around 8 or 9 years. My GFR is a bit low but the doctors assure me all is good. Who can argue with that??

Hugs

Jojo

John,

2 and 3/4?  Is the doctor a Harry Potter fan? (not sure how that joke will go over) Or does that mean Grade 2 with areas of Grades 3 and 4?  That may be something you need clarification on.  The staging of the tumor has a lot of weight over how the doctor goes forward with how you are watched.  For instance, my tumor was Grade 2 and I just get ultrasounds twice a year but with a more aggressive grading the doctor may want to do CT, for instance.  

HOWEVER, you will notice in most of the literature that, with regards to kidney cancer, size matters.  Below I'm posting a link to a "nomogram" from Fox Chase Cancer Center; basically you input your information and it gives you survival rates based on your situation.  You will notice that the biggest prognostic factor is often size of tumor and changing the grade doesn't really change the prognosis a whole lot.  It would just be nice to know.  I haven't heard of doctors grading tumors in fractions before... However that may be a new thing.

But you are correct in that we are very lucky and our outlook is great.  So take a breath and be thankful that it is OUTSIDE of your body.  Better out than in.

Here's that link:  

http://labs.fccc.edu/nomograms/main.php?nav=0&audience=2

- Jay

APny said:

Yes, let us know what he

Yes, let us know what he says.

They count the number, shape and size of the cells in a given sample and rate them on a 1-2-3-4 scale, with 4 being the most mis-shapen/aggressive type, with more of them in the sample area.

And they do use a hyphenated range.  On initial path. mine was a 2/3.  On the final they determined it was 3/4.  Most of the information for stageing comes at the beginning- i.e. Clear Cell Renal Cell Carcinoma, T2, N1, M1 tells other physicians that I had Clear Cell (as opposed to other types), that the tumor was over 7cm and not over 13 cm at it's greatest point, that it had gone to one or more nodes, and had metastasized to another organ. The Fuhrman grade provides info on how deformed the cells are, but is only useful to a treating physician.  I have never seen it brought into chart notes by oncology or my internist-just in the path reports.

On paper, you can have the same type and staging numbers as the next person, but your body is individual in how it reacts to surgery, medicines prescribed for other reasons, and drugs given for treatment of cancer. 

Welcome to Disneyland; and if your are old enough to remember the E tickets, it's a wild ride that has just begun.

Luck of the Irish to ya'

donna_lee

Scorpion_John said:

Donna

The staging was t1a Nx Mx, and it was clear cell, as for the grade... 2-3/4 is how it's typed.. so what would you understand that to mean? 

Most all of your answers are on the web-and here are some of places if you or others want to look or print out copies.  In your search engine, type in topics like "Kidney Cancer Staging", "Kidney Cancer Fuhrman Scale", "ACS Cancer Staging."  These will give you a great overview and are accurate.  Be wary of some sites as they are littered with pop-up ads for products, etc.

That said, there are 2 stages.

1. Clinical Stage, which is the initial diagnosing physician's best extimate of the disease based on physical exam, lab tests, and imaging tests.  I had a regular physical with my new Dr. and he ordered labs and a UA.  I mentioned some symptoms I was having more related to the gall bladder and he also ordered an Untrasound of the abdomen.  Didn't get the results until after the US was read, but the UA showed blood in the urine (not noticeable to me) and the US showed a large mass in the r. kidney and mass(s) in the liver.  Saw the oncologist next day, discussed options-was given 5-7 months to live if nothing was done.  He** No, I won't go!!!  Had a confirmatory CT of chest/abdomen/pelvis; and a bone scan that indicated it hadn't mets to bones.  Was sent to urologic and thoracic oncology/surgery specialists and set up for surgery.

and 2. Pathological Stage is clinical findings plus what is found during surgery and visual exam of removed tissue.  That's how they determined mine was Clear Cell RCC, T2N1M1.  The T2 would now be described as T2b because of the tumor size that was confined to the kidney (had not invaded vessels or gone through the fascia covering the kidney.)  The N1 was for finding it in 2 of the 11 nodes just behind the location of the kidney.  The M1 was for the one large mets in the left lobe of the liver.  And for good measure, they examined the bile duct and gall bladder and removed the gall bladder due to a congenital defect and an extra growth of tissue in the bile duct.

Then there is a description of Pathological Staging.

Yours, Clear Cell is the most common type. then T1a Nx Mx.

T is the size of main or primary tumor and whether it's grown into nearby areas.  Yours at T1a means it was 4 cm across or smaller. 

N is the extent of spread to nearby or regional lymph nodes.  Yours at Nx means it was not in local nodes. 

M is if it has metastasized to other organs.  Yours an Mx means the presence of distant mets cannot be determined. 

Kidney Cancer Fuhrman Scale (named after a Dr. who first used the microscopic exam and nuclear grading system of cancer cells in several kinds of cancer.)          -Looks at the size and shape of the nucleus as a whole.  -and the size of the nucleoli.  -and the chromatic lumping.

The I,II,III, or IV is to designate how closely the cancer cell's nucleus resembles a normal kidney cell nucleus.  In Grade I, the nucleus looks very much like a normal kidney cell nucleus; it is usually slow growing and are slow to spred to other parts of the body.  In Grade IV, it looks quite different from normal cells and has a worse prognosis.

Mine did "come back"- a recurrence-or had already mets to two other nodes in other parts of the body.  Each was found on follow up CT's as nodes that had enlarged and became evident on a subsequent CT.  Each was removed surgically, and nothing else has been found to be cancerous since 2008.

I'm not a Dr. and not in the mode to predict or guess at someone's prognosis.  You just look at the numbers and live on.  All I will say is that your Staging looks good-they caught early on-and I would love to have your numbers.

Good luck.

donna_lee