I’ve been a lurker here starting 25 days ago when my DH received the report from an MRI (for an unrelated issue) that a 3.6 cm mass on right kidney was “suspicious for RCC.” The rest of the MRI was “unremarkable.” Since then, the following has happened and I could use some input:
DH was referred by his GP to a prominent Urologist at major medical ctr with expertise in partial nephrectomy using DaVinci robot system. Options were discussed and it was agreed the partial was optimal choice, given his otherwise great health and size of mass.
Blood test and CT scan were done pre-surgery. CT scan proved “unremarkable” except for a sclerotic lesion near one shoulder. Another doctor with this practice ordered a full body bone scan to rule out metastasis due to the abnormality (the sclerotic lesion) on the CT. Full body bone scan found no evidence of mets. Tech explained that the sclerotic lesions were symmetrical at the shoulders and not the same “glow” that mets would indicate, and that probably the marks meant the start of arthritis in shoulders, and that bone metastasis often presents randomly on the skeleton on the scan. These tests together with blood test, they ruled out mets.
Partial nephrectomy was successful, no complications. Pathology confirmed clear cell RCC, Stage T1a at 3.3 cm (I still need to ask about the grade), negative margins. We have another follow-up in a few days, but what we know thus far is DH will be under surveillance with scans, initially, every 6 months.
Given this info, I have questions for those of you who have time to offer input:
1. Does it seem we’ve covered all the bases thus far, given that there are no mets as far as anyone can tell?
2. DH has been dealing with GP and an expert Urology team. His Urology surgeon treats many cancers, but I don’t see that he’s "certified oncologist." We are confident with his care, he’s truly top-tier, but I’m curious if/when an Oncologist might join his team of caregivers. Does that only happen if the RCC appears as distant mets?
3. Given that the tests mentioned above found no mets, and given that the T1a tumor was excised with negative margins, does a surveillance-only follow up for the time being seem sufficient? It seems to me that it IS sufficient for now, given all I’ve researched in reputable places (PubMed, ACS, Kidney Cancer Assn, etc.). I guess the reason I ask is that people keep asking me about what comes next like chemo (which I know RCC doesn’t respond to), radiation, meds. It almost makes me feel like I’ve missed something. But it would seem if pathology confirmed negative margins and no evidence of mets to be seen on any scan thus far, there would be no need yet for further treatment.
Any feedback you can give is greatly appreciated. Your posts are very helpful for posters and lurkers alike. You are all very kind, and very brave. Many thanks-