incomplete removal of kidney tumor, how to do next?

umd

From CT and MRI scans, it was incidentally found in Feb that there was a 1.5x1.5x1.4cm solid mass near the lower pole of my right kidney. I went to a local urologist and the doctor (in fact, who was not good at kidney surgery, I found later and now regret very much to let him do surgery) said this was the simple and most idealized case with much confidence and he can easily remove the whole mass by a lapascopic surgery. So, I trusted him and had the surgery in May. The pathology report said that it was conventional clear cell RCC (grade 2 of 4). My biggest concern is that the report also indicates that the tumor extends to the margin of the resection; there is non-encapsulated tumor in the base of the resection, although partially encapsulated. The specimen is 2x2x0.6 cm. It appears that the tumor was not completely removed. Is this right? I do not understand why the doctor removed such a small area that was even smaller than CT/MRI indicated. The surgery failed. I will have to change to another kidney surgery expert to save my life. My biggest concerns are (1) Do I need another surgery immediately to remove the remaining tumor in my right kidney? Or remove the whole right kidney? (2) Does this failed surgery (incomplete removal of the tumor) lead to cancer spread to other places? I worried very much.
I am in MD, where to find a real kidney cancer expert?

icemantoo

Make sure your facts are correct
Make sure first that you have your facts correct. The fact that your specimen is smaller than your tumor may mean they only did the pathology on part of the tumor. Or it could mean that the size of the tumor was incorrect on the CT scan or MRI. My tumor on the CT scan was 2.7cm and when they remived it it was 4.2 cm. Tumors change size and the size of the tumor on a CT scan is an estimate by the radiologist and is not 100% accurate. If there is still a problem and you know not just think the Surgery was unsucessful see another Urologist who specializes in Kidney Cancer surgery. Two suggestions. One is to call the Urology Department at Johns Hopkins University for an appointment. Second call Cheasepeke Urology which is the largest Urology practice in Maryland (44 Urologists a few of whom specalize in Kidney Cancer surgery). I know one of the Urologists there who does not do this type of Surgery and when I told him about mine he said these surgeries are done by some of the younger Urologists who have just come out of these training programs specializing in these new Kidney Cancer techniques.

umd

icemantoo said:

Make sure your facts are correct
Make sure first that you have your facts correct. The fact that your specimen is smaller than your tumor may mean they only did the pathology on part of the tumor. Or it could mean that the size of the tumor was incorrect on the CT scan or MRI. My tumor on the CT scan was 2.7cm and when they remived it it was 4.2 cm. Tumors change size and the size of the tumor on a CT scan is an estimate by the radiologist and is not 100% accurate. If there is still a problem and you know not just think the Surgery was unsucessful see another Urologist who specializes in Kidney Cancer surgery. Two suggestions. One is to call the Urology Department at Johns Hopkins University for an appointment. Second call Cheasepeke Urology which is the largest Urology practice in Maryland (44 Urologists a few of whom specalize in Kidney Cancer surgery). I know one of the Urologists there who does not do this type of Surgery and when I told him about mine he said these surgeries are done by some of the younger Urologists who have just come out of these training programs specializing in these new Kidney Cancer techniques.

Thanks very much.
The
Thanks very much.

The pathology report said the tumor extends to the margin of the resection. That means positive margin, this is what I am worried.

icemantoo

umd said:

Thanks very much.
The
Thanks very much.

The pathology report said the tumor extends to the margin of the resection. That means positive margin, this is what I am worried.

While I can understand that the report showed a positive margin, that is a desciption of the tumor, not the fact that something was not done or that they did or did not address anything with the lymph nodes. Review the pathology report with your doctor before you jump to conclusions.

Icemantoo

suzika

MCV in Richmond, VA has an
MCV in Richmond, VA has an incredible urologist and urology department. http://www.vcu.edu/urology/people/guruli.html Dr. Guruli took on my surgery when several other doctors would not do it.

The entire department there is incredible though.

Ok, having said all that, if you aren't comfortable get a second opinion. Especially, since the pathology report shows unclear margins. Good luck and keep us informed.