Understanding pathology ...

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Understanding pathology ...

by jensboys on Sun May 17, 2009 12:00 AM

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I had a lapriscopic partial nephrectomy on May 11th.  My tumor was 1cm and discovered accidentally in the process of donating (well trying to) my kidney to my cousin.

 My surgeon seems very calm with the idea that I, at 35, had a cancerous tumor and feels that two follow up ct scans at 6 and 12 months is probably enough.  Somehow I am not reassured.

So, can you help me understand the pathology report?  I dont have any pending referral to an oncologist and really the internet information is overwheming, .

 Tumor Type:  clear cell carcinoma

Fuhrman grade - 2 out of 4

Tumor size - 1 cm

Renal capsule involvement - none; resenction margins - none (3-4 mm from painted margin),  No adrenal or distal tissue involvement, no vessel invasiion, no renal pelvis involvement, no lymph nodes

A circumscribed tumor is seen which has a capsule and is made up of small cells forming clusters of varying sizes.  Cells have a clear cytoplasm and a small round nuclei with only mild cytological abnormalities.  The capsue is intact and the tumor does not extend into adjacent fat or to the painted margin.  Attached fat shows no abnormalities. 

Diagnosis:  1 cm yellow tumor with focal hemorrhage, painted margin grossly 3 mm

RE: Understanding pathology ...

by JulieUK on Mon May 18, 2009 12:00 AM

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Your post shows that good deeds can definitely bring rewards! It's extremely hard to diagnose RCC early, because it is so often asymptomatic until it is considerably advanced, sometimes even terminal.

So, although you may not feel it, you've had a lucky break!

I'm glad the tumour has been dealt with surgically (by the way, as you probably already know from your cousin's sad situation - and I hope they manage to find a suitable donor - the kidneys have a lot of redundancy in them, ie, there is considerable over-capacity, so it's possible to get a lot of function out of a partial kidney, or, indeed, one with a massive tumour in it - my husband's tumurous kidney was still functioning, despite a tumour the size of a football in,on, and around it!).

I suspect the reason the surgeon is saying no further treatment is necessary is simply because at this early stage, that is probably so. Basically 'he's got it all'.

At the moment, my understanding is that drugs are only used when the tumour is either inoperable in the kidney, or when the cancer has reached stage IV, and has metastasised to distant organs via the bloodstream (typically lungs, liver, brain, bones for RCC).

I believe there are tests running to see whether any of the latest drugs (primarily Sutent) can have an adjuvant/preventive effect on what early stage patietns have to look out for, which is recurrance.

Metastasis is now thought to occur (depressingly) rather earlier in general across cancers than was previously held, and so it could be that some of the tumour cells are still in your body, lying 'dormant'. This dormancy can last for years and years and years  - I believe there are patients who have had recurrance something like l5 years later!

But whether Sutent can kill off these 'dormant' cells is what is not yet known. One argumetn is that it can't, as Sutent acts by preventing tumours growing their own blood supply, and so it can't zap cancer before it gets to that stage of its development.

In your situation, therefore, it does sound like it's a question now of 'watch and wait' - you need to be on the alert for recurrance, either in the kidney iteself or in any possible metastases. Don't wait for symptoms, insist on regular scans FOR THE REST OF YOUR LIFE.   Docs, not unnaturally, like to tell people they're cured, but do not take the chance on recurrance 'taking off unnoticed'.

Again, in your situation I would definitely want a referral to an RCC oncologist (and be sure it's an RCC specialist, as RCC is a 'differnt' cancer and needs a specilist in it!). Surgeons, again not unnaturally, do have a tendency to think 'the knife is the only answer' (!) (just as, to be fair, physicians think 'drugs are the only answer' etc etc!).

To find a good one in your area, and also to get the best information about your situation that I think it's possible to find on the Internet, take a look at kidney-onc. It's an ACOR (Association of Cancer Online Resources - they have groups for all sorts of cancers). Many people here are there too, and it's run by two extremely knowledgeable people, to whom I would put your situation and see what they say (that Furhman grade may be a cause for future concern??). It is the largest single pool of RCC experience and expertise, and I highly recommend it.

 

You can join on http://cancerguide.org/kofaq/  (be warned, you get a lot of mails, so you may want to receive the digest or create a dedicated email address of your own for it!)

 All the very best, and it's great that this has been diagnosed so early. RCC is very slow growing, and can be in us for years and years before it makes its deadly presence felt. HOPEFULLY this is the last you've seen of it.

 

Julie

 

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