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Kidney Mass - RCC?

keephopealive11's picture
keephopealive11
Posts: 21
Joined: Dec 2011

I am 48 yrs old dad with two beautiful young daughters, and had a sudden right low back dull pain and pressure 3 days ago. Went to the ER, and found there is 6cm kidney mass from CT. "There appears be hemorrhage in the upper portion of the mass". I asked being transferred to another hospital for a second opinion. Had a multiphase CT (including contrast). "in the mid to lower pole of the right kidney, there is a 6x6.1cm complex mass most suggestive of a hematoma, This demonstrates no enhancement after contrast administration". I was discharged from hospital, and asked to follow up with urology in 4-6 weeks for another check. Assumed that the blood will be absorbed in few weeks so the next scan will reveal the underlying. BTW, the mass almost in a perfect cycle. My question is that to be waiting for 4-6 wks will cause the cell spread? I had feeling that the kidney will be removed anyway by giving the mass side so why wait? Thanks in advance for any inputs!

MikeK703's picture
MikeK703
Posts: 235
Joined: Sep 2010

Hi,
I can tell you that waiting 4-6 weeks for a nephrectomy due to renal cancer is not unusual. Many of us here have had to wait that long or longer, having been told that kidney cancer is slow to grow and metastasize. I was told there was more than a 90 percent chance that my mass was cancer yet had to wait 6 weeks for surgery. I'm not sure I understand the two descriptions you received -- "a hemorrhage in the upper portion of the mass" and "complex mass most suggestive of a hematoma." The first one sounds like a hematoma on the mass and the second one sounds like the mass and the hematoma are the same. Did anyone tell you the likelihood that it is cancer? It appears they aren't sure yet and thus the wait. I know little to nothing about renal hematomas, e.g., causes or treatment, but I'd root for the second description. Meanwhile your name, "keephopealive," says it all. Let us know the outcome.
Regards,
Mike

Jamie1.3cm's picture
Jamie1.3cm
Posts: 188
Joined: Jan 2011

No. A hematoma is like a bruise -- a collection of blood. This is not likely to be kidney cancer. Of course, one might wonder how you got such a hematoma on your kidney. Probably a broken blood vessel or a clot of some sort. So, it doesn't have quite the same tone as kidney cancer, but depending how it does or doesn't resolve, you'll want to talk to a urologist or nephrologist.

garym's picture
garym
Posts: 1651
Joined: Nov 2009

keephopealive,

I'm also confused by the dx, it does not sound like rcc to me, but the word "mass" is disconcerting. If there is a mass in conjunction with a hemorrhage waiting for things to clear up is the right thing to do, 6 cm is relatively small and sounds likely to shrink. If there is evidence of rcc it is slow growing so you have plenty of time. If surgery is required, there is a good chance a partial nephrectomy would save most of the kidney. Spend some time researching your condition, put together a list of questions for your doc, and form a plan of attack. We'll help you any way we can as well.

Good luck,

Gary

keephopealive11's picture
keephopealive11
Posts: 21
Joined: Dec 2011

Thanks for all the responses! I had the MRI last week, which showed "complex mass with area of hemorrhage ans areas of enhancement". The urologist from Johns Hopkins University recommended a surgery to remove the kidney considering 95% kidney mass is cancer. I wish I can keep partial of my kidney, but also worry about the spread if not totally removal...Sounds like people with one kidney can maintain the normal life (but for how long?)

foxhd's picture
foxhd
Posts: 1923
Joined: Oct 2011

We can live normal lives with one kidney. I'm sure you have heard of people donating kidneys to others in need. We are lucky in that respect.

foxhd's picture
foxhd
Posts: 1923
Joined: Oct 2011

My older sister was found to have had only one kidney.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

According to a relative of mine who is a physician, there are many people who lead long, healthy and happy normal lives who are found on autopsy to have been BORN with only one kidney! There was no indication during their lifetimes that this was the case.

It sounds as though it would be crazy (and probably impossible anyway) to save part of your kidney. I've just had an 8cm tumour and my whole right kidney removed. So far I don't even know whether the tumour was cancerous but it was an easy decision to make to take the whole lot out because even if it wasn't cancerous yet it sure as hell would have got to be further down the line. If the whole kidney is removed there is a fair chance that that will be the problem solved. If only part is taken you run the risk that they haven't got all of the cancerous material out. Since you don't need two kidneys, why take that chance? As my surgeon put it to me, the only downside is that you've got less reserve - you had one plus a spare and now you don't have the spare.

keephopealive11's picture
keephopealive11
Posts: 21
Joined: Dec 2011

Thanks Texas_wedge, you are right. Why take the risk. Sounds you just had the surgery very recently. How does the recovery go? I wish everyone Merry Christmas and Happy New Year!

DMike's picture
DMike
Posts: 238
Joined: Nov 2011

I had an open partial nephrectomy on December 6th. I questioned by urologist/oncologist about radical vs partial and he told me the statistics show no real difference in recurrence between the 2 methods. He removed a 5 cm mass and saved 75% of my right kidney. The pathology report showed clear margins around the mass. I'm very happy with the results. Just working through the recovery now. 3 weeks on Tuesday, gains are smaller now but I'm still moving forward.

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

I think perhaps I should clarify my posting in view of DMIke's - it's horses for courses. There are, of course, good reasons (quite a few of them and widely different) for partial nephrectomies. Some patients are lucky and have truly massive tumours that turn out to be benign. At the other end, there are unlucky folks who have small tumours which contain very aggressive forms of cancer.

Generally, rate of growth and size are useful indicators. I believe that for cysts in kidneys there is one accepted cut-off at around 7cm. over which size the odds become much less favourable. This is important because biopsies in vivo are not reckoned a good idea for at least a couple of reasons. One is the small risk of needle-path tracking of cancer cells to unaffected tissues when doing the biopsy. A more important reason is that there is about a 25% chance of a false negative outcome so that potentially lethal tumours could escape detection and treatment. So in a case like mine it made sense to whip it out and biopsy later to establish whether it was nasty or not (probably was - I guess I'll find out next week). My tumour was fairly large and awkwardly located. I'm 69 and have a slender torso so these practicalities strongly indicated a radical op. (like David, I enquired about a partial and accepted the expert judgment of my consultant). In David's case, with a smaller tumour and the stats. he was given, a partial was indicated.

Your situation is one where I think the radical is the correct option. Since you're probably feeling a bit nervous right now, let me add that David had his op. on Dec. 6th and is doing well. My op. was on the day before David's (but thousands of miles away!) and I'm also doing well - very active all day long, not tired at all and in no pain. We're probably both being sensible and letting our recovery progress without pushing it and if you do likewise you'll come through it fine. Just be warned that you'll almost certainly be very sore for the first couple of days after your op. but that's what pain meds. are for!

Good luck and keep in touch with us when you're able.

T.

DMike's picture
DMike
Posts: 238
Joined: Nov 2011

Keephopealive,
Trust me, I was only trying to say there are reasons for doing a partial at times. As Texaswedge says it's horses for courses. I never meant to cause further concerns. I care too much about the people here and what they are dealing with to offer anything but info and hope. All my best to you!
--David

foxhd's picture
foxhd
Posts: 1923
Joined: Oct 2011

Unless I'm missing something. Get the damn thing out.

keephopealive11's picture
keephopealive11
Posts: 21
Joined: Dec 2011

DMike, Texaswege, and everyone on this discussion board, I want to say thank you again. I know everyone here cares about me and all the patients. So please keep the open dialogue and share the information. Together, we can fight this disease!

braswelm's picture
braswelm
Posts: 41
Joined: Oct 2011

If the other kidney is healthy, don't be concerned with just having one. The main thing is to eliminate the chance of the cancer spreading.
I had a left radical nephrectomy (lap) on Nov 23, had to have a larger incision due to the 7.8 cm tumor, but am recovering fine. Still regaining strength, but returning to work part time tomorrow. Just obey the doctor and don't lift anything for a month or so, and you will be OK. The surgery and first few days after are not a walk in the park, but stay positive.
And definitely stay in touch on here, we'll be waiting for updates.
Mike

Texas_wedge's picture
Texas_wedge
Posts: 2807
Joined: Nov 2011

Not everyone's interested in the latest research but for those of us who are - I've just read a paper you might find worthwhile. It's entitled: "The expanding role of partial nephrectomy: a critical analysis of indications, results, and complications". I hope I'm accurately reflecting the main points in offering you the following summary:-

Advances in equipment and expertise mean that 'nephron-sparing surgery' or 'partial nephrectomy' (PN) is becoming ever better and thus there is an increasing number of cases where it is a viable alternative to RN (radical nephrectomy). So, the criteria for choosing between PN and RN are developing rapidly.

This paper, published in Feb. 2010 in European Urology, the official journal of the European Association of Urology, represents a comprehensive review of the 69 most relevant articles in English language publications. It demonstrates that there are compelling reasons for choosing PN, when appropriate, because of better OS (overall survival) and prevention of CKD (chronic kidney disease).

So, the key question is: when is PN appropriate? At present it seems that the main criterion is tumour size and the recommended cutoff is 4cm. It is to be expected that the prospects with larger tumours will improve with further advances in expertise but for now there is higher morbidity (meaning, roughly, incidence of disease) after PN on larger tumours.

It's always a matter of horses for courses but the risk-benefit ratio is shifting. However, for keephopealive11 the right choice still seems to me to be pretty clear.

T.

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