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Kidney Cancer Archive Questions

Below are Dr. Heather Mannuel’s answers to Kidney Cancer questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 53.

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Q : 1

Can someone with stage I RCC develop bone metastasis? I was under the impression this just wasn't possible.

It would be unusual, although not impossible, for a patient with stage I renal cancer to go on to develop metastatic disease, but I agree that further evaluation is warranted. I'd recommend consulting with an orthopedic surgeon who specializes in cancers in the bone. This way you can get a larger, surgically-obtained biopsy that would provide more tissue to make a definitive diagnosis.

Q : 2

My father (79) had kidney cancer in 1983. The kidney was removed and he has had no issues until now. Two months ago, a swollen lymph node was detected on a CT scan. A surgical biopsy determined it was clear cell renal cancer. After 30 years of remission, what are the possible treatments for this situation?

Kidney cancer can have a remarkably long latent or remission period in the body, although thirty years is significantly longer than most. There are many new and promising treatments for kidney cancer. Most of these are in pill form and fairly well tolerated aside from causing some fatigue and nausea. If your dad is in good health, he should be able to tolerate one of these treatments without significant difficulty. Additionally, given his age and the very long, slow course of his disease, if he doesn't have any cough/shortness of breath or other symptoms, his oncologist may want to avoid all treatment in favor of following CT scans over the next few months.

Q : 3

I am a 50-year-old male in good health who underwent a radical nephrectomy in 2003. After 8 years, I had a 15mm rcc tumor completely excised from my left lung. No mets were observed on the PET-CT. What follow up treatment would you advise? Is the time interval between recurrence in my favor?

Traditionally, a recurrence such as yours has been treated by surgical removal of the metastatic site, as has been done in your case. As multiple new drugs are being discovered and utilized to treat metastatic renal cancer, we're beginning to look at using them in new ways, such as in the adjuvant setting where the drugs are given after surgical removal to try to "mop up" any remaining cancer cells that are too small/too few to be seen on scans. This is still not standard of care treatment at this time, however, and the drugs aren't without side-effects and toxicities; so unless you have access to participation on a clinical trial, I'd recommend close follow-up with scans every 3-4 months for the first year, then extending the scans further out to every 6 and then every 12 months over the subsequent years. I agree that the long time period between the discovery of your cancer and the recurrence in the lung suggests that your cancer is somewhat indolent and slow-growing; however, I'd still advocate close follow-up and evaluation via scans and physical exams to be sure that the cancer isn't becoming more aggressive.

Q : 4

I have had a gross hematuria off and on for years along with slight discomfort in the left and right flanks. The results of a CT Scan of my kidneys found: "An incidental 2.8 cm simple-appearing cyst in the superior pole of the right kidney. There is not urinary tract calcification or mass." Why doesn't the result simply say "simple cyst?" I am 60 years old, obese, and have family history of a variety of cancers. Should I have the mass removed? Should there be follow up? Can I be monitored by an ultrasound or MRI?

Unfortunately, scans are limited in their ability to discern between benign and malignant conditions, and the episodes of recurrent gross hematuria are concerning. Evaluation by an experienced urologist who deals with kidney and bladder cancers will be very important in your case. The best time to identify cancers or even potential cancers are when they're small and localized, and fortunately it sounds like this lesion is solitary. Your urologist will be able to discuss the merits of watchful waiting via CT scans or ultrasounds versus a need to intervene to determine the cause of the bleeding.

Q : 5

My dad is 67 years old. His urologist ordered an ultrasound and CT scan on his kidney to identify a mass that he has. The doctor said it is probably cancerous, but wants to wait and see if gets any larger. Does this seem reasonable to you?

It depends on several factors, including the size and location of the abnormal mass and also how healthy your dad is overall. If he's in good shape without a lot of other medical issues, surgery to remove the mass would likely be fairly easy. "Watchful waiting" may be a feasible option as long as your dad is watched very closely with scans and exams, particularly if he's dealing with health issues that would otherwise make removal of the mass difficult or dangerous. It would be reasonable to get a second opinion from another surgeon who has experience in removing similar masses to see if their recommendations are different.

Q : 6

How common is kidney cancer in adolescents age 20 and above?

Although it is rare compared with older adults, renal cancers can be found in adolescents and young adults. Any symptoms such as abdominal pains, unexplained weight loss/fatigue or passage of blood or clots in the urine should be evaluated promptly.

Q : 7

I was stationed in the boiler rooms and machinery spaces on ships built in the 1940s. The boilers, pipes and steam equipment were insulated with asbestos. We made repairs using a mix of asbestos and paste. Can asbestos lead to renal cell carcinoma?

Cancers of the lung and mesotheliomas are strongly associated with asbestos exposure. While a few cases of renal cancer have been reported in association with asbestos, larger analyses have so far failed to show a definite association.

Q : 8

My mother, age 64, was diagnosed with renal cell carcinoma. The kidney was removed and her surgeon said the tumor had not spread elsewhere. Should she have preventative chemotherapy just in case something was missed outside the kidney?

At this time, the standard of care is not to give patients adjuvant (post-operative) chemotherapy if their renal cancers are completely removed. There is an ongoing study at the University of Maryland and other institutions that is trying to answer the question of whether this kind of adjuvant treatment is effective in preventing or delaying progressive kidney cancer, so our answers and the standard of care might change over the upcoming years depending upon the results of that study.

Q : 9

I have just had my kidney removed with a tumor 10cm in size. What are the chances of this spreading to a lymph node or to one of my lungs? Should I be seeing a urologist or should I be going to an oncologist for future screening?

The risk of tumor spread will depend upon several factors, including the specific type of tumor and whether it had spread outside of the kidney to the surrounding fat or lymph nodes. I'd recommend that you see both a urologist and a medical oncologist to discuss these issues, and they can help establish the best and safest way for you to follow up with scans & exams.

Q : 10

I was having right side pain and my doctor ordered a CT scan which revealed a cyst on my liver and another on the left adrenal gland. Six months later a CT scan showed significant growth in the adrenal cyst and no cyst on the liver. I was sent to a surgeon who wants to do total left adrenalectomy. All my 24-hour urine tests have been normal as well as all my blood work. Do I really need a total adrenalectomy? I have no pain, no hypertension, no symptoms of Cushing or Conn's. I would not mind a biopsy or removal of tumor, but am really reluctant to have total adrenal gland removal.

This is a pretty classic conundrum in patients with adrenal masses, as things can look pretty suspicious on scans and end up benign when they're looked at under the microscope (and vice versa). In similar cases we tend to discuss the pros & cons with both surgery and Endocrinology prior to committing the patient to surgery. I'd recommend seeing an endocrinologist who specializes in adrenal abnormalities to get a better idea of the risks and benefits of surgery versus close "watchful waiting" with scans and monitoring.

Q : 11

One of my friends has a family history of renal cell cancer and a personal history of papillary thyroid cancer. What yearly screening method would be recommended for her?

There isn't a widely-accepted screening test for renal cancer, which is one of the unfortunate reasons we tend to see the disease in more advanced stages unless it's incidentally detected. If your colleague doesn't have a personal history of renal cancer and is asymptomatic without abdominal pains or weight loss, insurance most likely won't pay for an abdominal ultrasound or CT; however, given her personal & family cancer history, any symptoms should be promptly evaluated with imaging. Microscopic hematuria (blood in the urine) can be an early indicator of renal cancer, and I would recommend that this be checked during her annual exams.

Q : 12

Is there a specific medical test that accurately identifies kidney cancer?

Unfortunately, there is no test that can perfectly predict or identify kidney cancer or precancerous tumors. When suspicious findings are seen on an ultrasound or CT scan, an MRI may provide a clearer picture of whether a tumor is present. However, the only way to be absolutely certain is for the area to be removed by a surgeon and the tissue identified under the microscope.

Q : 13

I have transitional cell cancer to one kidney and the other kidney is scarred from the passing of many small kidney stones. Are there other treatment options besides nephrectomy?

Depending on the extent & location of the cancer, you might be eligible for kidney-sparing surgery. If your cancer is in such a location that you absolutely need the nephrectomy, you may still be able to have relatively normal function from the remaining kidney. Although any future medications you need (antibiotics, chemotherapy, pain medications) will need to be dosed carefully with your limited kidney function in mind.

Q : 14

During a MRI looking for a herniated disc, I was diagnosed with stage 3 renal cell carcinoma. I had a radical nephrectomy of the right kidney and associated lymph nodes along with the renal artery were removed. I am meeting with an oncologist and I don't know what types of questions to ask. Are there foods I should avoid to help retain the health of my left kidney?

Congratulations on recuperating from a tough surgery - the unknown is always scary, but it sounds like your tumor was limited and, hopefully, completely removed at this time. It's good that you're meeting with a medical oncologist in a timely manner. Our philosophies about treating patients who've had their kidney cancer completely removed are in transition. Currently, the standard of care is to give chemotherapy only to patients who have cancer left over in their system after surgery (for example, cancerous areas that have spread to the bones or lungs). Fortunately, it sounds like you aren't in this category. We're still investigating whether giving a short course of chemo to patients who had all their disease removed surgically is helpful in preventing the return of their cancer. This approach is called adjuvant therapy, and there are clinical trials going on across the U.S to address exactly this question. If you're not a candidate for a trial or if you don't feel comfortable enrolling in one, then the best course of action will be "watchful waiting" with follow-up scans and exams done on a regular basis through your oncologist's office. In terms of nutrition, the best action is to eat a well-balanced healthy diet, same as I'd recommend even if you didn't have cancer. I tend to be more concerned about medications, as many antibiotics and painkillers get removed by the kidneys. Make sure all of your health-care providers know that you have just one kidney, as they'll want to be careful to dose medications to reflect any change in kidney function that you might have now.

Q : 15

How long would it have taken for a papillary type 1 renal cell carcinoma tumor to grow to a massive 22cm x 15cm x12cm mass?

Difficult to tell since tumor 'grade' can be an important determinant of how quickly the tumor progresses. It can potentially take years for very small lesions to grow that big.

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