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 43.

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Q : 1 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 : 2 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 : 3 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 : 4 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 : 5 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 : 6 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 : 7 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 : 8 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 : 9 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 : 10 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 : 11 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 : 12 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.
Q : 13 04/16/2007	My brother, 42 years old, has kidney cancer with mets to his ribs, spine and 2 glands. The kidney tumor was not operable. He has just finished his third cycle of Sutent, and now the doctors will take him off and replace it with Nexovar, even though the last 2 CT´s show no new growth. They have found some shadows on his lungs, but cannot tell if it is cancer (present since he was diagnosed). He has fluid building up in his lung, and they suspect cancer, so they feel Sutent is not working. How early can you tell if it is working or not? It can take several months to see a response, which generally occurs in about 30 to 40% of patients. If there is fluid build up (I assume pleural fluid), this is of potential concern, and he may need it tapped and sent for cytology. If his physicians feel that there is indeed progression, then it would be reasonable to switch to Nexavar, although data in this regards is limited. One suggestion is to potentially tap the fluid, and then continue the Sutent for a couple of additional cycles before giving up on it. If there is disease stabilization but not response on Sutent, this would also be of value in advanced renal cancer.
Q : 14 03/24/2007	I am a retired 63-year-old male, 290 lbs, good health, normal blood pressure, sugar levels, etc. Owing to lower back ache in April 2005, my HMO did a CT and reported that nothing was found. Severe stomach pains sent me to the ER in July, 06. CT was done and diverticulitus was diagnosed. The hospital later discovered on the CT that I had a 2.3 x 1.8 cm soft tissue density mass along the medial cortex of my right kidney. Based on the 2006 CT, my HMO was ready to surgically remove the kidney mass until they discovered that I had the previous CT in April 2005. They pulled the film and discovered that the mass was there but that it had been overlooked. The mass was the same size. My HMO Dr. decided to wait and watch for six months. A CT in March 2007 shows the mass has not changed in the two years. My Dr. believes we should just watch and see what if anything develops. I'm scared as kidney cancer, once it metastases, is often loo late to "cure." Do you have an opinion on my unchanged right renal mass? If the mass has been stable in size for the past two years, it is not unreasonable to continue to monitor this with serial imaging, and intervene if there is a change in size. One possibility is to also obtain a dedicated MRI of the kidney and ultrasound which may perhaps help define the "mass". Ultimately, the only way to be sure would be to remove it unless the "mass" has specific radiological characteristics for a benign lesion. In general, biopsy of a suspicious kidney lesion is not recommended (due to risk of bleeding) but rather the lesion is removed surgically. This is a decision you will need to make together with your physician.
Q : 15 03/06/2007	My brother-in-law was diagnosed with Renal Cell Carcinoma about 6 years ago. His kidney was removed but the cancer metastisized to his lungs. Initally he was given a treatment of IL-2 and the lesions in his lungs shrank to practically nothing, and remained that way for approximately 4 years. Then they began to grow. He was given a lower dose of IL-2. The lesions stayed the same for 3 months and now they are beginning to grow. His next visit is in May. His doctor said if they see growth, he will have to be treated. The question is: Since more treatments are becoming available for RCC such as Sutent, Nexavar, etc., what do you suggest he should be treated with? He is in perfect health and these lesions are still very small. Thank you so much. If the lesions are growing, then I think it would be very reasonable to use one of the above agents you cited (Sutent or Nexavar), assuming that your brother has clear cell renal cancer. If he progresses on this, there are ongoing trials assessing other agents after Sutent/Nexavar.

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