Small Renal Mass Recurrence

APny said:

They are currently monitoring

They are currently monitoring two small sub-centimeter growths (cysts, lesions, take your pick, lol), one on each of my kidneys. They think they were there prior to my surgery as well and since they're stable and not growing we're leaving them alone but watching them. Cysts are common so I wouldn't be terribly concerned at this point.

Wel, Joe, I am sorry you are going through this finding extra tumor.

I cannot offer you any comparisons, but would you want to consider a 2nd opinion?

At least they found it and its small.

Keep  us informed as to how you are doing, k?

Hugs, Jan

jason.2835 said:

Argh!

JoeMoose,

Here's hoping its a cyst and not connected to the original tumor... If it's the same kidney though that seems weird that they didn't see it initially.  I suppose it is possible that you would have to occurrences of cancer in the kidney that aren't connected?  

I'm wondering what they would consider the staging on this one as it is still in the kidney.  At least it is still small and therefore manageable.  Try to stay positive... this is why we get scanned regularly; to find these things early.  It is always better when found early.

- Jay

Hi Joe,

I agree with Andi and Jay....it could well be cysts. Although it is probably a little distressing knowing that it is there, try not to worry too much. At least they are keeping an eye on it.

Hugs

Jojo

JoeMoose said:

Small Renal Mass Recurrence

Sorry guys. I wish it was a cyst. The Dr. told me it is solid and he is pretty sure it is another mass. I should have mentioned that part... Initially I was trying to go down that path as well. But unfortunately it is not the case. Any thoughts??? And thanks again for responding to me. 

That sucks, Joe, I'm so sorry. But please get a second opinion. It is pretty unusual to have two unrelated masses in one kidney. Have someone else interpret your scans; it can't hurt.

a_oaklee said:

A couple comments.  Typing on

A couple comments.  Typing on phone.  

First, sorry you have this new finding to be concerned about.  If i were you, i would get copies of my scans, always!  Also, get a pathology report copy.  Always check these things yourself.  

Im wondering if you have any family history, because you are young.

Also, your first scan was at 6 months, and the second was 10 months?  I always thought standard interval is 3 months initially.  I could be wrong.  But i wouldnt want to wait another 10 months to do a recheck.

And i agree that you should get a second opinion with an rcc expert.

It seems to me that it must be fairly common practice for different doctors to follow vastly different protocols. I had a small (2.4 cm, grade 2) tumor removed, and then had one follow up CT scan 3 months later just to create a reference image. No additional follow up after that at all. Its what my surgeon said was normal as it would be very unusual for any kind of recurrence in my case. And I'm content with that since I really couldn't afford any regular follow up, just to be most likely told that everything is ok.

APny said:

Please don't neglect follow up testing

Sheeple, with all respect to your doctor, why have a reference image if there will be no further follow ups? I think you should have follow up ultrasound scans every six months if your insurance won’t pay for the much more expensive CT scans. And for stage1 US is perfectly acceptable. Having a small chance of recurrence is not the same as no chance, unfortunately, so I really don’t think you should take that chance. I was also stage1 and am getting US and chest x ray every six months. Please continue getting follow up scans. The best thing you could hear is that everything is OK.

The purpose of the reference image is so that if I happen to need an abdominal CT sometime in the future, the radiologist will have something to compare it to at that time. Yes, I am aware the chance isn't zero, but I'm also aware that I have a much better chance of getting seriously injured in a car wreck but that doesn't stop me from driving to work everyday. Life has risks, some greater than others. Don't sweat the small stuff I say, and for me the likelihood of a recurrence falls into that category.

APny said:

Okay, that's one way of

Okay, that's one way of looking at it

Sheeple,

My nephrectomy was done at a major teaching hospital.  My surgeon said that they follow NCCN guidelines which are followed by many doctors and hospitals.  I'm listing the NCCN guidlines for Stage I followup care.  My opinion is that I would get an opinion from an oncologist before making a final decision about followup.  Urologists are experts at removing kidneys, not experts with cancer.  My urologist didn't even order a chest CT before or after my nephrectomy which should have been an obvious necessity for a 9cm grate IV tumor that would have a high risk of recurrence (and it did).  Maybe the oncologist will concur with your surgeon, but below are the NCCN guidelines for Stage I:

• History & Physical every 6 months for 2 years, then annually up to 5 years after nephrectomy
• Comprehensive metabolic panel and other tests as indicated every 6 months for 2 years, then annually up to 5 years after nephrectomy
•  Abdominal imaging:
•     After Partial Nephrectomy:
•         Baseline abdominal CT, MRI, or US within 3 – 12 months of surgery
•         If the initial postoperative scan is negative, abdominal CT, MRI, or US may be considered annually for 3 years based on individual risk factors
•     After Radical Nephrectomy:
•         Patients should undergo abdominal CT, MRI, or US withing 3 – 12 months of surgery
•         If the initial postoperative imaging is negative, abdominal imaging beyond 12 months may be performed at the discretion of the physician
• Chest imaging:  Chest x-ray or CT annually for 3 years, then as clinically indicated
•  Pelvic imaging as clinically indicated
• CT or MRI of head or MRI of spine as clinically indicated
• Bone scan as clinically indicated

Sheeple said:

I did have 2 appointments

I did have 2 appointments with an ocologist, but all he did the first time was speak to me for about 30 seconds and schedule a following appointment for 6 months later. At that second appointment I told him what my surgeon had told me about me not needing any kind of follow up and he basically agreed. And so, none was scheduled. At this point I'm not even certain how I could go about getting a basic chest x-ray or CT since I no longer have an oncologist and I seriously doubt I could get a referral to one at this point as there is no clinical indication that I need it.

Joe, as I said, we’re monitoring two small lesions, one on each kidney. But they believe them to be simple cysts so it’s a bit different from yours being solid. If yours hasn’t grown any perhaps surveillance is the best approach, especially how it’s located in the middle of your kidney. I would however want a second opinion. Is the oncologist you’re going to see the same one who recommended the wait and see approach or a different one? I was advised against cryoablation, saying it’s mostly for those for whom surgery is high risk. You can’t do pathology on ablated tumors as they’re destroyed so that’s another concern. Again, something to discuss with your oncologist.

Sheeple, you could approach your surgeon and/or urologist and ask that they schedule an x-ray and an US. US is much cheaper than a CT and as I said, perfectly acceptable protocol for stage 1. That’s what Sloan Kettering is doing with me. Six month US and chest x-ray and I’m happy with it. So do see your surgeon/urologist and get it scheduled. I don’t think zero follow up is a good idea, at least for the first three years.

JoeMoose said:

Small Renal Mass Recurrence

Good news!!! Bad news... I prefer to look at it like it is good news. My newly detected mass was actually on my scans going back to June 2014 (prior to the removal of my 1.7 cm mass). So basically it has not grown in 15 months... sad part is that they would have probably taken it out if they saw it. In the end, i am happy.... just doing surveillance (I do not have much of a choice at this stage) - not worth the risk with the size. Plus they would have trouble finding it during surgery and/or removing it. Take care all. Thanks

I take it as good news too. If it has not grown at all in a year and a half chances are it's nothing urgent. Just keep monitoring it like they do with mine.