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 46.

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Q : 1 10/12/2009	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 : 2 10/06/2009	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 : 3 08/08/2009	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 : 4 07/24/2009	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 : 5 05/12/2009	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 : 6 02/23/2009	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 : 7 12/21/2008	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 : 8 10/06/2008	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.
Q : 9 10/02/2008	I have a small (0.8 cm) solid lesion and a second cystic lesion on the left kidney. If a kidney lesion is "solid" and I also have a lesion on my liver, what types of questions should I be asking? I just want to make sure I'm fully aware of what cystic vs. solid lesions might mean. In general, solid lesions in the kidney are concerning for cancer, whereas mixed cystic lesions can also be suspicious. Pure simple cysts, which have characteristic features on imaging, are relatively common as we age and are benign.
Q : 10 09/06/2008	I have been receiving Interferon Alfa every 4 weeks off and on for two years. I have had some hair loss, but most of my hair is still there. Does that mean the drug is not working the way it should? Also, if Interferon Alfa is a biological drug, why is it part of my chemo regimen? Thank you so much. The classification between the different classes of various anti-cancer therapies is somewhat arbitrary, but in general Interferon is considered "biological therapy" or "immunotherapy," as opposed to classic "chemotherapy." As part of treatments, several different agents are often combined. Interferon may not necessarily cause significant hair loss and therefore I would not use this as a parameter to assess its efficacy.
Q : 11 08/04/2008	What it the mechanism by which a kidney tumor causes discharges of blood in the urine? What is the time it takes for progression from stage 1 to 4? Erosion of tumors into blood vessels can lead to bleeding. Tumor progression is a complex process, and depends upon tumor type, tumor histopathology (i.e., how it looks under the microscope), and tumor location, among other factors.
Q : 12 05/06/2008	My brother was diagnosed with renal cell cancer June 2007. He had intravenous chemo which helped for several months and then quit. Also had two types of oral chemo. The medical team that removed his kidney told us this cancer is very aggressive type, Stage 5, but that it is very rare and not a lot of research has been done. We really do not have a name for this cancer. Do you have any information or suggestions? Most renal cancers are clear cell type, which may respond to some of the newer drugs currently available. It appears your brother may have received one of these agents. However, the clinical course does suggest that perhaps the tumor is of a different type (histology). There are at least a half dozen other types of renal cancers, some with a very aggressive clinical course and not readily amenable to current therapies. Unfortunately, based on the information you have provided, I don't have any good recommendations.
Q : 13 03/27/2008	My husband had renal cell carcinoma in 2005. His doctors said it was contained. Now he has three nodules in his lungs. Doctors have been watching them for about a year. They have increased in size. The largest is 9mm, too small to biospy. Just wondering what you would recommend. I agree that I would not do biopsy. Unfortunately these nodules are likely to represent recurrence. If feasible, can they be completely resected? This is a question you should explore with the primary oncologist since sometimes long-term disease control can be achieved by resecting isolated metastatic sites in renal cell cancer. This may be especially true if the recurrence occurs several years after the primary local surgery. However, it is conceivable that the locations of the lesions may not be amenable to surgical removal. At some point, it may be reasonable to consider treatment with one of the newer FDA-approved agents in RCC, or possible participation in an appropriate clincal trial.
Q : 14 08/06/2007	I had a "minimally complex cyst" in my right kidney incidentally found through an MRI for another reason. I repeated the MRI and no change was found. It is now a year later, and I had an ultrasound as a follow-up. Now the right kidney cyst is not clearly visible, and a new cyst has been found in my left kidney. Which is the best scan to evaluate what is going on, an MRI or a CT scan? I lean towards the MRI because there is no radiation, and a CT scan is the equivalent of 400 chest X-rays. However, the urologist says he is "more used" to the CT scan. Ultrasound is another modality than can be helpful in characterizing a renal lesion, cystic vs. solid. Either MRI or CT should be useful in following the cysts. Do remember, renal cysts are relatively common, more so in men and with aging, and tend to be benign. Intermittent follow ups are reasonable with no intervention warranted unless there is a change in the cyst characteristics.
Q : 15 04/20/2007	My brother-in-law is being treated for kidney cancer. The pathology report says cells "are consistent with clear cell." His PET scan shows no tumors anywhere, but extensive spread to the bones. Is it possible to have cancer spread from head to femur (bony areas) without a tumor showing up in the kidney? I have personally not seen such a situation, although I have seen very small tumors within the kidney but extensive spread to other areas. Conceivably such a situation as in your brother-in-law can occur although would be quite rare. I believe if the pathologist thinks that the markers of the cancer in the bone are consistent with clear cell type RCC, then it would be reasonable to attempt targeting for such. There are several agents recently approved by the FDA that could be attempted for therapy.

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