Possible small renal mass

msdcastro

First os all sorry my English, I'm from Brazil. Incidental detection of an Exophytic Small renal mass like 1.5cm has been detected in unenhanced CT scan. Actually thebl image is a slight lobulation. After that, I did three US (one total abdomen and two urinary sistem specific) and showed just an small lobulation with the same tissue of my renal parenquima. The final exam will be a enhanced MRI because I'm allergic to iodate. The doctor told me, in case of renal tumor the best option is a laparoscopy partial nephrectomi but a second opinion told me open partial is more efficient, mostly for futures recidive. Both of then told me that in my case there's 95% of success to be totally cure and keep 6 months surveillance. I went in a third opinion that told me is better just to keep controlling if the mass grown brcquse is very small to know exactly the posssible malignance or not. Any opinion to help me a better way to take?

Bay Area Guy

I had an estiamted 1.5cm

I had an estiamted 1.5cm lesion in my right kidney found, also incidental, in December, 2013.  I was referred to a urologic oncologist at Stanford University.  He recommended active surveillance, meaning scans every six months.  They alternated between unltrasounds and CT scans.  He told me that was the standard of care for lesions that size.  He also told me tjhat if I couldn't stand the thought of a possible cancer inside of my body, he could arrange to have it taken out right away.  He recommended the active surveillance because he did not want to impact my kidney function if he didn't have to.  In April, 2016, an ultrasound showed that the lestion had grown to 1.8cm, so he recommended taking it out.  He gave me the choice of cryo-ablation (freezing it and thereby killing the cancerous cells) or having it removed robotically.  He said the cryo had about a 90% success rate and the surgery about 99%.  He recommended the surgery, and I agreed that getting it out completely made more sense.

The "right answer" for you depends on how you feel about having the mass inside you.  I went with my doctor's advice the whole way and we did the active surveillance until he was certain it was cancer.  As to robotic versus open, I can only tell you that my experience with the robotic was that it was easier than a couple of open surgeries I've had on my stomach in the past.  I was in the hospital only overnight and I went home with a little discomfort, but no real pain.  Hopefully, others will tell you their experiences both with robotic and with open so you have more information on which to base your decision.

The good news is that, just like with me, this mass was found very early and the prospect for a complete recovery and cancer-free life going forward is very good.

msdcastro

Bay Area Guy said:

I had an estiamted 1.5cm

I had an estiamted 1.5cm lesion in my right kidney found, also incidental, in December, 2013.  I was referred to a urologic oncologist at Stanford University.  He recommended active surveillance, meaning scans every six months.  They alternated between unltrasounds and CT scans.  He told me that was the standard of care for lesions that size.  He also told me tjhat if I couldn't stand the thought of a possible cancer inside of my body, he could arrange to have it taken out right away.  He recommended the active surveillance because he did not want to impact my kidney function if he didn't have to.  In April, 2016, an ultrasound showed that the lestion had grown to 1.8cm, so he recommended taking it out.  He gave me the choice of cryo-ablation (freezing it and thereby killing the cancerous cells) or having it removed robotically.  He said the cryo had about a 90% success rate and the surgery about 99%.  He recommended the surgery, and I agreed that getting it out completely made more sense.

The "right answer" for you depends on how you feel about having the mass inside you.  I went with my doctor's advice the whole way and we did the active surveillance until he was certain it was cancer.  As to robotic versus open, I can only tell you that my experience with the robotic was that it was easier than a couple of open surgeries I've had on my stomach in the past.  I was in the hospital only overnight and I went home with a little discomfort, but no real pain.  Hopefully, others will tell you their experiences both with robotic and with open so you have more information on which to base your decision.

The good news is that, just like with me, this mass was found very early and the prospect for a complete recovery and cancer-free life going forward is very good.

Many thanks to share your

Many thanks to share your experience

icemantoo

I answered

---a similar post from you a few days ago, but it seems to be no longer there. Same answer. They are all reasonable options and you should go with the doctor you are most comfortable with. There is no single right or wrong answer.

 

 

icemantoo

msdcastro

icemantoo said:

I answered

---a similar post from you a few days ago, but it seems to be no longer there. Same answer. They are all reasonable options and you should go with the doctor you are most comfortable with. There is no single right or wrong answer.

 

 

icemantoo

Yes, because one of the

Yes, because one of the doctors told me could be a dromedary hump due to US results, that's common in the left kidney. But I'm not comfortable. Thanks for your reply.

a_oaklee

1.5 cm is very small, so it

1.5 cm is very small, so it makes sense to me to watch it and repeat scans in 3 months.  I do believe, from our experience, that it is important where the mass is located in whether there would be more  urgency in getting it removed or waiting.  

todd121

Location of the Mass

You might ask your doctors to consider the location of the mass in addition to the size of it. I had what was considered to be a Stage 1 mass (under 7 cm) and would have been Stage 1 cancer when removed according strictly to imaging. However, it was located in the center of the kidney right where all of the blood supply enters the kidney so I was ineligible for a partial. They couldn't figure out how to get it out without destroying the blood supply. They took the entire kidney and when they did the pathology it turned out the mass had grown into the internal blood supply in the kidney so I was Stage 3 instead of Stage 1 and I did have a recurrence 2 years later.

It sounds like yours is outside the center of the kidney of you are eligible for a partial. Active surveillance seems reasonable as is a partial. I'm not sure why an open partial would be preferred to a laparascopic partial. It seems like most people here have laparascopic partials. That question is better asked of your doctors and you might want to get 3 opinions if you have 2 differing opinions on that and ask them to explain the data behind their opinion before you decide.

Regards,

Todd

AnnissaP

Hi. I am sure you will have

Hi. I am sure you will have more direction and info once the MRI is completed. If it IS cancer then I would not want to keep that in my body (just my personal opinion). Good luck and all the best to you with your care and decisions.

msdcastro

Anyone knows a kidney cancer

Anyone knows a kidney cancer survivor longer than 20 years after surgery? Doctors like the word Cure, but no recidive is realy feasible?

Bay Area Guy

msdcastro said:

Anyone knows a kidney cancer

Anyone knows a kidney cancer survivor longer than 20 years after surgery? Doctors like the word Cure, but no recidive is realy feasible?

iceman is, if I recall

iceman is, if I recall correctly, a sixteen year survivor.  The guy that used to do our gardening was treated for kidney cancer about ten years ago and he's still going strong.  You have to remember.....your kidney mass, if it's cancerous, is quite small.  As I said before, it's the size mine was when mine was discovered.  My urologic oncologist, my surgeon and my primary care physician all said that surgery would cure....yes.....cure.....the cancer.  Could they guarantee that it won't come back?  Not a 100% guarantee, but they all said it was about 99% certain not to come back.  I'll take those odds any day.  But no one can give you a 100% guarantee that it won't come back.  Then again, no one can give you a 100% guarantee that you won't get hit by a bus in the morning.  But the odds are very, VERY good that you won't get hit by a bus, just like the odds are in your favor that the cancer will not return.

On a side note, my brother-in-law, in 2009, was diagnosed wwith nasopharangeal cancer.  It's a cancer that hits the back of the nose and throat.  He was diagnosed at Stage 4A and when we heard that, we figured he was a goner.  Radiaition and chemotherapy didn't just control his cancer, they eliminated it.  He has been cancer free for nine years now.  Again, he was Stage 4A!

I think you are trying to talk yourself into a worse case scenario here.  The advancements that have occurred in the past few years and those that are still under development in the treatment of not just kidney cancer, but all cancers, are pretty amazing.  I'm almost 63 years old and I am convinced that I will live long enough to see cancer become more of a nuisance disease than a deadly disease, one that is either cured or controlled by a combination of surgery, drug therapy, gene therapy or immunotherapy.

icemantoo

msdcastro said:

Anyone knows a kidney cancer

Anyone knows a kidney cancer survivor longer than 20 years after surgery? Doctors like the word Cure, but no recidive is realy feasible?

Faye

https://csn.cancer.org/node/237554

 

Read about my former neighbor up North. She is about 23 years since being nephed and now in her upper 80's.Also kwew someone my age at about 20 plus years out. Why atop at 20  years.

 

 

icemantoo

msdcastro

Yes, sometimes I caught my

Yes, sometimes I caught my mind thinkingthe worst scenario mostly because of my 4 years old daughter. I would like to see her development, graduation, etc. This is my biggest fear. Thanks for all reply of you guys.

msdcastro

Many thanks

Many thanks

msdcastro

I would like an opinion of

I would like an opinion of who lives in the United States 

 

 

 

I had an appointment with another urologist, recommended by a friend. His graduation was in Brazil, but he is a specialist from Urology Specialist in Cleveland, Ohio (7 years learning and working there) and affiliate with Uhhs Richmond Heights Hospital, came back to Brazil one year ago,

He evaluated my exams and his opinion is that the mass is a lobular mas from my own kidney. The size is really small to be concerned in a short time but reccomended CT or MRI scan with contrast to be 100% sure. He told me that IF the surgery is really necessary, he believes in a full recovery more than 95%.

My question for you guys, living in USA. Is this Hospital a reference in your country? I felt more confortable with this doctor more than others.

Thanks in advance

JerzyGrrl

msdcastro said:

I would like an opinion of

I would like an opinion of who lives in the United States 

 

 

 

I had an appointment with another urologist, recommended by a friend. His graduation was in Brazil, but he is a specialist from Urology Specialist in Cleveland, Ohio (7 years learning and working there) and affiliate with Uhhs Richmond Heights Hospital, came back to Brazil one year ago,

He evaluated my exams and his opinion is that the mass is a lobular mas from my own kidney. The size is really small to be concerned in a short time but reccomended CT or MRI scan with contrast to be 100% sure. He told me that IF the surgery is really necessary, he believes in a full recovery more than 95%.

My question for you guys, living in USA. Is this Hospital a reference in your country? I felt more confortable with this doctor more than others.

Thanks in advance

Cleveland

I've heard good things about University Hospitals -- and Cleveland Clinic, too. Also, what he's telling you is typical of what we would expect you'd be told by a reasonable RCC specialist. That you're more comfortable with this doctor -- That's great! You want someone who you can communicate with well and with feel comfortable with.

Keep us posted --

msdcastro

todd121 said:

Location of the Mass

You might ask your doctors to consider the location of the mass in addition to the size of it. I had what was considered to be a Stage 1 mass (under 7 cm) and would have been Stage 1 cancer when removed according strictly to imaging. However, it was located in the center of the kidney right where all of the blood supply enters the kidney so I was ineligible for a partial. They couldn't figure out how to get it out without destroying the blood supply. They took the entire kidney and when they did the pathology it turned out the mass had grown into the internal blood supply in the kidney so I was Stage 3 instead of Stage 1 and I did have a recurrence 2 years later.

It sounds like yours is outside the center of the kidney of you are eligible for a partial. Active surveillance seems reasonable as is a partial. I'm not sure why an open partial would be preferred to a laparascopic partial. It seems like most people here have laparascopic partials. That question is better asked of your doctors and you might want to get 3 opinions if you have 2 differing opinions on that and ask them to explain the data behind their opinion before you decide.

Regards,

Todd

exophytic mass in the lower

exophytic mass in the lower middle third pole

msdcastro

Update

Just to keep posting, Today I did an US (3 months before the first unenhaced CT) and still showing nothing diferent. According to the Radiologist Doctor, only a slight lobulation from my own renal parenchyma. Nothing hyperecoyc/hypoechoic image. I don't know if it means something really positive, or if Ultrasound could have a not good accuracy for a small renal mass. I will keep my original plan to do a MRI an the end of my business trip in October. Any opinion?

todd121

msdcastro said:

Update

Just to keep posting, Today I did an US (3 months before the first unenhaced CT) and still showing nothing diferent. According to the Radiologist Doctor, only a slight lobulation from my own renal parenchyma. Nothing hyperecoyc/hypoechoic image. I don't know if it means something really positive, or if Ultrasound could have a not good accuracy for a small renal mass. I will keep my original plan to do a MRI an the end of my business trip in October. Any opinion?

Small Mass

With that small a mass in the outer lobe, I think you're doing fine to observe it with imaging for awhile before making any decisions about surgery. However, you might want to do one MRI now and another in the future so you can see if it grew/changed instead of waiting. If it were me I'd rather have 2 high definition scans with contrast/enhanced to compare the results 3 or more months apart so you can judge if it is growing or not.

Usually they do CT with contrast. It's preferred over MRI for some reasons I can't explain. But I think you said you are allergice to the CT contrast and that's why you have to have an MRI?

Todd

msdcastro

todd121 said:

Small Mass

With that small a mass in the outer lobe, I think you're doing fine to observe it with imaging for awhile before making any decisions about surgery. However, you might want to do one MRI now and another in the future so you can see if it grew/changed instead of waiting. If it were me I'd rather have 2 high definition scans with contrast/enhanced to compare the results 3 or more months apart so you can judge if it is growing or not.

Usually they do CT with contrast. It's preferred over MRI for some reasons I can't explain. But I think you said you are allergice to the CT contrast and that's why you have to have an MRI?

Todd

Yes, I'm allergic. Thanks for

Yes, I'm allergic. Thanks for your reply todd121

msdcastro

Update

I had an appointment with my Urologist yesterday. I took my last ultrasound and my blood and urine tests. All good. According to his opinion, I have a fetal lobulation, not a nodule. I've mention that two Radiologist Doctors did the Ultrasound exam, one of them who is CT Radiologist too mention that she's not consider the image from previous CT was a nodule image, but a lobulation. In short, he reccomended keep watching every 6 months by Ultrasound, if something changes, perform a MRI with contrast. If nothing changes, just live my life. I'm still confuse if I have to make contrasted exam nown ou can relax at least for 6 months.

Any advice?

Thanks in advance.

msdcastro

msdcastro said:

Update

I had an appointment with my Urologist yesterday. I took my last ultrasound and my blood and urine tests. All good. According to his opinion, I have a fetal lobulation, not a nodule. I've mention that two Radiologist Doctors did the Ultrasound exam, one of them who is CT Radiologist too mention that she's not consider the image from previous CT was a nodule image, but a lobulation. In short, he reccomended keep watching every 6 months by Ultrasound, if something changes, perform a MRI with contrast. If nothing changes, just live my life. I'm still confuse if I have to make contrasted exam nown ou can relax at least for 6 months.

Any advice?

Thanks in advance.

My last exam

After 1 year of my last exam, I did a US Color Doppler in the best clicnic in Brazil and the result was "Small lobulation, anatomic disform without signs of nodular lesion". I'm very happy with the results.

The urologist explain to me that the vascularity of the kidney is normal and uniform, if there's any nodule the vasularity is easy to detect wuth the exam in this place.

Someone can advise if I can finaly relax after one year of investigation?