Kidney Cancer Grading

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The grade affects the prognosis, but doesn't currently affect treatment. The treatment is the same for a given stage regardless of the grade. Grade also correlates with stage in that larger tumors tend to be higher grade.

The most widely used and most predictive grading system for renal cell cancer is the "Fuhrman Nuclear Grade". Your pathology report should use the Fuhrman Grade. Fuhrman grade is on a scale of I-IV, where grade I carries the best prognosis and grade IV the worst.

Nuclear grade means that the system is based on just the appearance of the nuclei of the cancer cells, rather than the appearance or structure of the cells as a whole. Nuclear characteristics used in the Fuhrman Grade particularly indicate how actively the cells are making protein.

Nuclear Characteristics Used in the Fuhrman System

  • Size and shape of the nucleus as a whole.
  • Number and size of nucleoli (Nucleoli are organelles found in the cell nucleus which make ribosomes which in turn are protein making factories. More nucleoli implies more active protein synthesis).
  • Chromatin clumping (Chromatin is the substance of chromosomes and contains DNA and associated proteins. I'm not exactly sure why clumping indicates a more aggressive tumor).

Grade I

Very little different from normal kidney cells. These cancers usually are slow to grow and spread and tend to have a good prognosis.

Grade II

Clear-cell renal carcinoma with nuclei that vary in size and are generally larger than in grade I tumors; nucleoli are slightly visible.

Grade III

Clear-cell renal carcinoma with cells that exhibit large nuclei with marked variability in size and shape; nucleoli are large.

Grade IV

Looks quite different from normal kidney cells and has a worse prognosis

References/Other Descriptions

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