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Should I biospy

Clmac
Posts: 23
Joined: May 2016

I had been experiencing extreme fatigue, ankle and feet swelling and just general sick feeling. I had a CT w/contrast and it was recommended to follow up with renal ultrasound for further eval. The U/S revealed a 4cm "structure" with internal separation. My GP says a biopsy to be safe because CT shows "hyperdensity". Anyone have input ? 

icemantoo's picture
icemantoo
Posts: 3217
Joined: Jan 2010

clmac,

 

My initial reaction is no based upon what I have seen on this board. But first a 4cm whatever it is should be evaluated by a Urologist, not a GP. That is my tought. Go from there.

 

Icemantoo

lcsvb's picture
lcsvb
Posts: 40
Joined: Jan 2016

Go straight to the Urologist. Most of the time a biopsy is not done because they are not very reliable. Most of us here had the "suspected RCC mass" surgically removed and then biopsied. I highly recommend a trip to a nearby urologist, especially if there is a cancer center you can get in at.

amyjoe23
Posts: 14
Joined: Apr 2016

What do you mean it's not very reliable? My husband had a kidney biopsy 2 weeks ago, and it came back clear cell renal cell carcinoma? We already knew he had cancer, and I didn't understand why they had to do a biopsy.

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todd121
Posts: 1425
Joined: Dec 2012

A positive tells you something. A negative can mean they missed the tumor, missed the spot, missed cancer cells in the tumor. Kidneys are filters. They aren't very solid. Tumors can have odd shapes, pockets of healthy tissue, etc. Biopsies are not an exact science.

A biopsy to find out what kind of cancer is important. Kidney cancer can be in the lungs, liver, brain, bones. The treatment for kidney cancer is completely different than the treatment for lung cancer. In fact, even different types of kidney cancer are treated differently (as are different types of lung cancer, breast cancer, etc.). They absolutely need to know what kind of cancer they are treating. Biopsy or removing the tumor and looking at it sliced up under a microscope is the best way (the last is the absolute best) to know what they are dealing with.

Regards,

Todd

Clmac
Posts: 23
Joined: May 2016

Thanks guys, they are doing a referral to the urologist, hopefully will know more 

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todd121
Posts: 1425
Joined: Dec 2012

If you can see a urologic oncologist, even better. That's a urologist who specializes in kidney masses. 4 cm is pretty good size. Hopefully they can tell what it it is without biopsy or surgery. Kidney biopsies are hit and miss. I'd make sure whoever makes that decision knows what they are doing. A urologic oncologist is the best person to make this decision. My doc was a urologic oncologist who is a specialist in this area and he did not recommend a biopsy for me. My mass was over 6 cm.

The problem with kidney tumor biopsies is a positive helps, but a negative does not. A negative biopsy is confirmation of nothing. It's easy to miss the tumor, miss the cells within the tumor that are indicative of something.

Best of luck to you,

Todd

Clmac
Posts: 23
Joined: May 2016

Thanks Todd,

I agree with all that you've said..I had thyroid cancer and the biopsy was a negative result, the pathology post-op was papillary cancer so I'm apprehensive about the whole ordeal. The not knowing an "inconclusive" is worrisome...and the fact it was called a 'structure'.. I deeply appreciate everyone's input.

Clmac
Posts: 23
Joined: May 2016

And auto correct messed up original post , should have said "internal septation"..did anyone have that diagnosis initially?

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sblairc
Posts: 586
Joined: Feb 2014

That's interesting, you had a more complex and thorough test used to diagnose kidney cancer and they are now recommnending an ultrasound.  Perhaps that's a good sign. Did your CT scan reference any "enhancement?" Usually these buggers light up on the scan as having vascularity (own blood supply) and it's mentioned in the report. Your information seems to suggest cysts or something (opinon strictly based on my reading here from others experiences). 

Clmac
Posts: 23
Joined: May 2016

The CT w/contrast was for another issue and the kidney was an incidental finding.. I'm in rural TN, probably not the best healthcare lol. It says there are hyperdense areas and hypoenhanced.  The finding concludes "within the lower right pole of the right kidney a relatively high density structure is seen . further characterization with renal ultrasound is suggested. That was last Monday, and I had the ultrasound on  Friday, with the results I discussed earlier. A 4cm "structure" (and i have no idea why they keep using that term )in the lower pole of the right kidney with internal septation. 

sblairc's picture
sblairc
Posts: 586
Joined: Feb 2014

What an unusual term to use, "structure" So vague and un-medical I would call and ask.  I bet your urologist appointment will clear things up. Do you know why your grandma had her kidney removed? Make sure you tell your urologist that. Keep us posted!

Clmac
Posts: 23
Joined: May 2016

I have no idea , its unnerving to see that too ! Should get a urology consult within the week and go from there..I think my GP is causing unnecessary worry based on this discussion:) I'll be happy to just get definitive answer

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hardo718
Posts: 853
Joined: Jan 2016

Maybe you have an architect hanging around in there....haha!  Try not to get too hung up on the terminology.  Sounds like they need more clarity as to what they are looking at and what you have growing in you.  In a sense, it is a structure I guess, cells are arranging themselves in the form of a growth much like bricks in a building. 

The important thing is to find out from a specialist if this is something that needs to be razed, much like a building that's housing squatters.

Looking forward to hearing your follow-up.

Donna~

Clmac
Posts: 23
Joined: May 2016

Lol ! Thank you Donna ! 

Also, did your initial diagnosis mention "internal septation"? 

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hardo718
Posts: 853
Joined: Jan 2016

Yup.  They told me that's what made it a "complex cyst" and of concern.

Clmac
Posts: 23
Joined: May 2016

Yup, that was my concern..and thank you !

Clmac
Posts: 23
Joined: May 2016

Will get to see urologist Wednesday it looks like , hopefully I'll have real answers.. But I'm feeling like its not good..my intuition was correct on the thyroid diagnosis too..funny how we know when something is wrong

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icemantoo
Posts: 3217
Joined: Jan 2010

Clmac,

Worst case, you  have a malignant tumor. The real world- The prognosis for a full recovery from surgery alone for a 4cm tumor is in the high nineties. I had a similar diagnosis almost 14 years ago. Been theren done that. You will be fine in any event. For now lets hope you do not have to join our club, but if you do we will welcome you with open harms and teach  you the secret handshake.

Icemantoo

Clmac
Posts: 23
Joined: May 2016

My faith in humanity restored with each response..whatever this week holds, I got this no doubt ( courage regardless) you have been great.!! Now , about that handshake ;) appreciate you Ice !

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hardo718
Posts: 853
Joined: Jan 2016

Sounds like my initial CT results and my urologic/oncologist referred to it as a "complex cyst".  The doctor I initially saw said there was a 80-90% chance it was cancer.  He was correct.  I got a second opinion, mainly because I didn't care for his bedside manner.  He dropped the cancer bomb on me and made no eye contact with me, just viewed the films on the computer the whole time. 

Good luck and keep us posted.  I'll keep you in my prayers.

Donna~

Clmac
Posts: 23
Joined: May 2016

I hope you're doing well Donna:) I have nothing to go and on and just have major concerns as my grandmother had her right kidney removed at 27 yrs old and I've had thyroid cancer..now I think I'm just paranoid !

Footstomper's picture
Footstomper
Posts: 1238
Joined: Dec 2014

Anyway you're not paranoid if its true

Clmac
Posts: 23
Joined: May 2016

Trying so hard not be !! But, I'm high anxiety by nature and this multiplied it by 10 :(

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foroughsh
Posts: 775
Joined: Oct 2014

Don't make worst conclusions,

If it's a kidney tumor then it's not recommended to have biopsy, it's not needed because it can be recognized by CT scan with/ without contrast and also having biopsy might give you wrong result and spread out.

A4cm mass -even if it's malignant- is treatable, it's probably stage  one and it's the best news you can expect with almost 85℅ of cure just after partial or radical surgery.

What you need is a urologist who is experienced with kidney cancer. Then trust your doctor and get ready for your treatment.

It might turn out to be benign, we've had such examples on this board

Keep us posted

Forough

Clmac
Posts: 23
Joined: May 2016

Urology is next :) 

mrou50
Posts: 389
Joined: Mar 2013

I just wanted to reiterate what everyone else has said get and expert to assist you not a GP, and I wish you good news with this.

 

Mark

Clmac
Posts: 23
Joined: May 2016

Waiting to hear back for urology referral;)

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Jojo61
Posts: 1310
Joined: Oct 2013

I agree - the not knowing is the worst! I wish doctors would realize that pussyfooting around, trying to save patients some anxiety actually enhances the anxiety! Just give it to me straight!! I know this is scary stuff to go through...wishing all the best results for you!

Hugs

Jojo

Clmac
Posts: 23
Joined: May 2016

I just want them to say no it's not or yea it is...don't like anticipation of what's next , if anything 

Clmac
Posts: 23
Joined: May 2016

So my doctor called around 6:30 and said her preference is to see a nephrologists after consulting with her colleague... I guess that's OK?

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hardo718
Posts: 853
Joined: Jan 2016

If you have a growth on the kidney, you really need to be seen by a urologist.  A nephrologist is a doctor that treats disorders of the urinary tract medically, not surgically. 

Therefore, if it is deemed you need a surgical procedure you'll end up needing to be seen by a urologist anyway.  Just seems like a waste of time & money.  (just my opinion)

icemantoo's picture
icemantoo
Posts: 3217
Joined: Jan 2010

Sometimes Nephrologists get involved with Kidney Cancer. Sometime there are Kidney function issues to be looked at.ets hope it gets resolved ASAP.

 

Icemantoo

Clmac
Posts: 23
Joined: May 2016

I'm really getting worried now about my docs decison making, maybe I'll just tell her tomorrow I feel better with the urology referral.

Clmac
Posts: 23
Joined: May 2016

She did say the radiology report says the right kidney is 11.9 cm, so a 4cm lesion would be considered big..really frustrated tonight with it..and I think I'm just going to do a walk in tomoreow and get things straight

icemantoo's picture
icemantoo
Posts: 3217
Joined: Jan 2010

Clmac,

Your 4cm lesion or in worst case scenerio a tumor is small to medium. Many members of our club would almost die for a tumor that small.

 

 

Icemantoo

Clmac
Posts: 23
Joined: May 2016

I'm not stressing about the size of it, I realize that's small in comomparison..not saying that its the end of the world, I just didn't like the comparison I was given. Thanks for everything and y'all take care

APny's picture
APny
Posts: 1947
Joined: Mar 2014

You need to see a urologist. Preferably a urologic oncologist. I don't think any of us on this board was sent to a nehphrologist after seeing a growth on the scans.

todd121's picture
todd121
Posts: 1425
Joined: Dec 2012

See if you can find a urologic oncologist. Most nephrologists aren't going to be interested if your kidney function is ok. If you had a blood test for kidney function (creatinine/BUN/eGFR) and they are normal, nephrologists just aren't likely going to be interested. They probably will send you to a urologist.

Nephrologists are internists. Urologists are surgeons. That's really the big difference.

You need to find out if this is something that needs to be removed. That's a urologist area decision.

I thought you already had a urology referral? Did that not happen?

Within urology there are regular urologists and then there are urologic oncologists. The second group are urologists that have additional training in kidney masses (cysts, tumors, etc.). A regular urologist is ok, but if you can see a urologic oncologist, that would be best.

Given the size is fairly small (not super small, but still if it is a tumor it's a stage 1 tumor probably) and if your kidney function is ok, it's not an emergency so don't get yourself too upset. If it is a tumor, they grow very slow. A few weeks or months is very unlikely to make a difference.

You'll get it sorted out soon enough.

Wishing you the best,

Todd

Clmac
Posts: 23
Joined: May 2016

She first told me that I would see the urologists..called back yesterday and said nephrologists. I don't think she knows what to do so I'm trying myself to get the appt. 

todd121's picture
todd121
Posts: 1425
Joined: Dec 2012

By the way, your family doctor sounds a little bit loopy. Are you happy with her? (I think you said her...)

Is she an MD? Is she certified in family medicine or internal medicine?

Might want to consider just visiting another doctor for another take on this if she's giving you the run around.

If you aren't happy, use your feet. I got 3 opinions from oncologists after my first surgery before deciding course of treatment. When 2/3 agreed, I felt a lot better.

She may be really good at other things, but this may just not be what she's good at. :)

Todd

Clmac
Posts: 23
Joined: May 2016

She's an MD..like you said, this apparently isn't her thing. And I'm not trying to be overly urgent because i do realize its small just that I work (2) jobs, have a home and family to take care of and don't want to cause any inconvenience to my job or family of I can prevent it

sblairc's picture
sblairc
Posts: 586
Joined: Feb 2014

Exactly why you should skip the nephrologist. It's small, but SO WHAT? You still need an appropriate standard of care. I don't think it sounds like seeing a nephrologist first is a good use of your time. And, you can always see one later. Don't waste your valuable time seeing a nephrologist first. 

Clmac
Posts: 23
Joined: May 2016

I called just now, again..and left a message for doctor telling her I don't want nephrology first...

APny's picture
APny
Posts: 1947
Joined: Mar 2014

Clmac, do you need a referal to see a urologist because of insurance reasons? If not, just look for a urologic oncologist that takes your insurance and make an appointment, bringing along all your scan results on a CD. You should be able to get them from the place that did them, along with a written report. You said you live in a rural area but even if you have to travel it's worth it. Please get proactive on your own behalf and look for someone. 

todd121's picture
todd121
Posts: 1425
Joined: Dec 2012

It's good advice. If you don't need her referral, find a urologic oncologist yourself.

This is what I did. From ER I found a nearby university medical school, looked online at their urologists and found the best qualified (head of the department that was a urologic oncologist) then called directly and made an appointment.

You can get a copy of the CD with your scan directly from the radiology department where you had the scan. You can also have them mail it directly to the doctor's office.

Hope this all helps.

Let us know.

Best,

Todd

foxhd's picture
foxhd
Posts: 3183
Joined: Oct 2011

walks like a duck, and quacks like a duck.......it needs to be removed sooner rather than later.  So refuse any biopsy. They will do that once it is removed. Sometimes I think people forget that we are playing with our lives not monopoly money. Now is the time to be vocal and uncompromising.

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