Kidney Mass-- Frustrations and Questions

Hello RussellD,

At 2cm there is an 80% chance this is cancer.  At that size surgery is curative no chemo and no radiation.  I am surprised that the insurance company is pushing back and wanting to do surgery.  I say this because ablation is cheaper than surgery.  This is only a guess but, some tumors are not in ideal place for ablation, so maybe that is why your insurance company is pushing back.  I will say that a partial nephrectomy is the gold standard for treatment.  I had a robotic partial nephrectomy done 4 years ago to remove two tumors from my right kidney.  I spent two days in the hospital, 4 days in a hotel room, and then was off for the next 6 weeks.  I could have gone back in three, but I had the time and the doctor at MD Anderson wanted me off for six weeks, so I took it. 

Fight your insurance company, you have time.  These tumors grow and about 4mm a year.  so there is a good chance you've been carting this around for a few years.  So take a month or two and fight the insurance company.

You also might consider getting a second opinion.  I say this from personal experience.  Find a urologist who specializes in kidney tumors.  Ask your current doctor how many partial nephrectomies he/she has done.

When you have about 30 min check out this video.  It helped me a lot.  The doctor is a urologist at MD Anderson

https://www.youtube.com/watch?v=493RFA_tA1I

sometimes there is recurrance after abalation. Also be prepared for more than 2 weeks downtime. I was 59 when I was nephed 17 years ago and my recovery was easing back to full time work after a month. Rememner the Doctor whp told you 2 week was holding ths scapel which is a little easier to recover from.

icemantoo

I had a slightly smaller lesion, same kidney as yours.  It was first discovered accidentally in late 2013, but active monitoring was determined to be the best course of action for me.  I Was hesitant about the surveillance, but I was assured RCC grows very slowly and the likelihood of spreading, given th3 size, was negligible.  So, active surveillance it was.  I had six month scans until April, 2016, when an ultrasound determined the lesion had grown by 0.1cm.  I was given the ablation vs surgery option.  The "success" rates I was given (remember this is three years ago) were 90%+ for ablation and 99%+ for surgery.  Despite hating the idea of another surgery (I had two previous abdominal surgeries for intestinal issues), I decided on the surgery, robotic/minimally invasive, because of the higher success numbers and because I wanted the lesion out, not just frozen or cooked.

Total Hospital time from check-in to discharge was 25-1/2 hours.  I went pretty slow on my recovery, mainly because I had the time as I am semi-retired.  The recovery was easier than my abdominal operations, but those two operations involved major incisions in my abdominal muscles and those things hurt when you move or, God forbid, sneeze.  The minimally invasive doesn't make large incisions, just a number of small ones.

As I said, I took the surgery option for the higher success rate.

My surgeon/oncolgist at MSK said that ablation is recommended for elderly people who are poor surgery risk and that the "gold standard" for everyone else is partial or full nephrectomy, depending on tumor size and location. With ablation there's no pathology and no way to get negative margins. I was totally convinced that surgery was the way to go. Perhaps you could arrange to work from home via computer? I really do believe that surgery is a better choice if unless you're high risk for it.

I think the insurance company did you a big favor.  You would never know via pathology what the tumor was and how aggressive it might be.  The best way to deal with it is to cut it out.  You have some time where you can plan for the surgery.   Disability insurance?  I wish you well.  There are lots of posts on here re postop partial nephrectomy.

You might have had your informed decision on your treatment. FYI, I just want to share my experience. Last December, I was incidentally diagnosed with a solid renal mass in size of 10x4x15 mm. I consulted with three urologist oncologists or surgeons, they all offered me three options: active surveillance, ablation plus biopsy, and robotic partial nephrectomy. But none of them recommended the ablation to me because of three reasons that were mentioned by other folks here. First, success rate of the ablation is lower than the surgery. Second,  the biopsy result is not as accurate as the pathology result after surgery since there is no way to be 100% sure if the mass is benign or malignant until it is entirely taken out of my body. Third, I am a good candidate and strong enough to have the surgery. I finally elected to go with the surveillance approach for some time first until I was spiritually, mentally, and physically ready for the surgery. Last month, I successfully went through a robotic partial nephrectomy treatment. I am on my way to recover and currently feel I have had recorded 80~90% of my pre-surgery status In terms of physical and mental strength. Good luck and best wishes.