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Scan Frequency Post Partial Nephrectomy for Low Risk Patients?

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

I had a partial in July 2014.  I was in the low risk group.  I had scans at 6 months and 1 year, both clear.  My next appointment is 1 year from now.  I thought I would get scanned every 6 months for 3 years.  But the guidelines from the American Urological Association say:

 

"Abdominal imaging (US, CT, or MRI) may be performed yearly for three years in patients with low risk (pT1, N0, Nx) disease following a partial nephrectomy based on individual risk factors if the initial postoperative scan is negative. (Option; Evidence Strength: Grade C)"

I am going to Memorial Sloan Kettering.  Is anual scanning the norming for low risk?

icemantoo's picture
icemantoo
Posts: 3216
Joined: Jan 2010

I had an initial scan at 5 months, than yearly for about 5 years. Than annual Ultrasounds with a final CT at year 12. I was also low risk. Guidellines are only guidelines otherwise the PA  or the nurse would schedule the scans. There is no one size fits all. Also what my URO would say for next year, when next year would come around he would change his mind. Even though I am low risk my URO has been watching cysts in the other kidney. Also since you had a partial (mine was in the pre partial days) there is a slight risk of spreading to the remainder of the kidney and they are still developing statistics for this newer procedure.

 

Please take these thoughts with a grain of salt as I have not been ordained as a doctor yet.

 

Icemantoo

Mike99's picture
Mike99
Posts: 22
Joined: Mar 2003

It is funny how each doctor treats post surgery scanning differently. I just had my Kidney removed due to a very large Renal Cell Carcinoma and they have me scheduled for 3 months for my follow up scan which is actually 4 months from the actual surgery date. I will have to let you know after my result appointment to see how long until my next one. The main thing I am saying is that each of these doctors have a different opinion as to when you need scans and a lot of time it is based on your pathology reports and the type of cell you had and if the Margins were clean or not. If you feel that you need to have them more often then you should talk to your doctor and let him know your concerns so he/she can explain to you why they are treating you that way. I am sure if they only did a partial that they were confident enough to tell you that you were "low risk". Just as an example this is my 3rd different cancer since 1998 and when I went through my first I was high risk with Liposarcoma and after my treatment was completed I was every 3 months then twice a year and then yearly for 5 years. They treated me differently than some of the other patients I was in the Chemo study with. Each of us had the same cancer but I guess we had a different make up because they treated us differently. I am not a doctor and this is only my opinion based on my own personal experiences. Good Luck to you with your recovery and I hope this helped.

avdoty's picture
avdoty
Posts: 62
Joined: May 2014

My partial neph was in May 2014 and my original plan was to have a CT Scan at 3 months post surgery, every 6 months for three years, and annually after that until I got to year 5. My first 2 post surgery scans were clean. My uro onc surgeon at Stanford Hospital said that I could modify it to annual scans after seeing my 2nd scan. My path report was pT1a pN0 and my tumor was less than 2cm. I'm in that low risk category so I agreed. The only concern I have is stopping them after year 5. At this point I'd like to continue beyond year 5 but I'll deal with it when they're over. 

Talmidah's picture
Talmidah
Posts: 25
Joined: May 2015

I had a partial nephrectomy for what turned out to be a T1a tumor.  My surgeon said to have a scan at 6 weeks post surgery and then annually after that because the risk of recurrence is low.  I imagine scans would be more frequent for more agressive tumors.

Sheeple
Posts: 19
Joined: Jul 2015

I was diagnosed with 2.5 cm pT1aG2 clear cell tumor after my partial nephrectomy. I had one abdominal scan 3 months post-op and was then told by my urologist that I didn't need any more follow up. I thought that was odd so I found an oncologist that agreed to annual chest ct's for 5 years. Well, a few weeks ago was when I was scheduled for my first chest ct and I decided to cancel it. In the year leading up to the appointment I had a change of heart and mind and now I feel comfortable with my urologist's assertion that I don't need any further follow up. I also canceled my account on this board since I didn't feel I had anything relevant to add to this board. I still lurk on the board and keep up with the old timers on here that originally helped me however. Your post finally gave me a reason to chime in. 

Galrim's picture
Galrim
Posts: 305
Joined: Apr 2013

T1 with no independant negative prognostic features has intervals of 6 or 12 months. The decision as to which one, is based on your overall medical condition and the absence/presence of both indepedent and dependant prognostic factors.

/G

Shecka1121
Posts: 114
Joined: Apr 2015

Hi there,

 

I met with my urologist/oncologist yesterday, post operative apt.  We discussed scan schedules in great detail.  My dr is also a MS in clinical research and has researched kidney cancer so she had a lot to say.

In her explaination and research, early stage 1 t1a (and the cut off for her is 3cm and not 4cm) the scan schedule that is going to be recommended more is a scan every 6 months for two years and anual scans for a lifetime.  The cut off should not be 5 years.  

She also explained in new studies that masses larger than 3cm (t1b) do behave a bit differently than smaller ones and the chance of local recurrence can happen as well as spread to nodes first.  She then stressed that recurrence of this happening is still within the 5% range so uncommon.

She explained the cormorbilites (sp) of why different scan options are used so for younger patients, MRI may be the more viable option due to less radition.  

Another intesting fact she explained that research on the smaller masses has been a bit difficult in some regard because people with Stage 1 kidney cancer do not follow through with scans.  I was a bit surprised by that but she said the percentage of people not engaging in scans is very high.

 

Thought I would share.

 

thanks

 

gingersnaps
Posts: 67
Joined: Jul 2013

Just one thing, T1a does not stop at 3cn. It stops at 4 cn. 

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

Shecka1121, that is excellent information.  Thank you!  I am glad I asked my doctor, and I am still waiting for a reply on if I will get scanned at 1.5 years.  Another difference between different doctors is type of scanning.  You said MRI is used, but my doctor is using ultrasound on my kidneys and a chest x-ray.   I plan to get annual scans as long as I can into the future, even if that means I have to go to the doctor and complain of abdmonial pain and ask the doctor if I can get a CT scan of my abdomen.

jason.2835
Posts: 337
Joined: Nov 2014

PMA,

My doc is doing every 6 months for 2 years, then yearly "after that." He hasn't put a final time table on that; I assume it'll be forever but I am probably wrong about that.  NCCN guidelines say 6 months for a year, then it is up to the doctor to decide on the second year, and then annually.  Overall, annual scans for pT1 are pretty standard from what I've researched.  My tumor was pT1a (less than 3cm), so I think that my doc's plan is ok with me.

- Jay

 

Positive_Mental_Attitude's picture
Positive_Mental...
Posts: 454
Joined: Jul 2014

My doctor' s office got back to me. I am going back in 6 months.  I feel kind of strange--do I want additional scanxiety in my life?   But seriously, this forum is so helpful, and the most important thing we all share here is a sense of questioning everyting and staying on top of everything we receive and are told.  I thought go to one year scans did not seem right, and I am glad I asked. 

APny's picture
APny
Posts: 1946
Joined: Mar 2014

I'm glad you asked too. I go every six months and while I hate the additional anxiety I feel more comfortable with more frequent follow ups.

HH431
Posts: 41
Joined: May 2015

It's going to also probably depend on the grade and type of kidney cancer.   Partial nephs are also not new and there is a lot of data regarding them.   They are always recommended whenever possible.  It also depends on the skill of the surgeon.  The first surgeon I went to wanted to remove the entire kidney as he didn't have the vast experience of doing them or at least more complex ones (although he would not admit that); the second surgeon I went to who did my partial has done more robotic partials than anyone else in the world.

I had the partial last month and my mass was 4.2 CM.  It was RCC - Chromophobe which is generally very non-aggressive and it's not even graded.  I'm told I probably had that tumor there for years.  I will have a scan and chest x-ray in 5 months, then once yearly for five years.  Chances of recurrence in single digits percentage-wise I was told in my case.  At 43, I am grateful to retain 80% of the kidney and had blood work done last week which showed no difference in my kidney functioning compared to before the surgery.  My kidney functioning has always been good.  

They will yearly alternate CT scans with ultrasounds.  I can do MRIs instead of CT Scans if I want.

 

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