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Accidental discovery of 6cm tumor

JohnThebuilder
Posts: 2
Joined: Apr 2018

Dear All,

 First of all , Please excuse my English.

My 34 years old husband has been disgnosed with 6cm tumor in his left kidney, the doctor proposed 2 options :

  • Surgery by Robot : Waiting list for 2 Months
  • Normal Surgery which can be done next week.

The doctor prefers the robot procedure, but 2 months looks very far away.

I'm very scared I don't want to lose my husband. from the report it can be read that the tumor spread to the rerenial fascia and surrounding fat stranding.

they are considering it T4 , I read online It's the final stage. but the doctor is telling me not to worry , I'm not sure if he is lying to me or we should consult another doctor.

 

Please help I'm lost

icemantoo's picture
icemantoo
Posts: 3286
Joined: Jan 2010

If the were my only options with a 6 cm tumor I would want to get it out earlier than later. That is a personal rather than medical viewpoint. 

 

 

icemantoo

 

Supersum's picture
Supersum
Posts: 103
Joined: Aug 2017

Sorry to read you are in this difficult situation.

I do not have a medical background.

Does the doctor (urologist?) give a very good reason why he prefers waiting for 2 months for robotic surgery?

I can only think that the surgery is less invasive. Normal surgery will involve a bigger wound, possibly greater pain afterwards (which can be easily controlled with pain killers), and longer recovery time.

Did the doctor say it would be better to use robotic surgery so they can remove everywhere the tumor has spread? If the doctor gives a medical reason for the delay you might like to quickly get a second opinion to check that it is for your benefit, although I don't know if this will be possible in your situation or where you can go to get a second opinion (which you only need if the doctor is promoting a 2 month delay). 

If he does not give a very good reason for the delay then I would say if I was in your situation I would want it out as soon as possible. I would not hesitate.

I do not know your situation but be aware that it is possible things can go wrong before surgery so you can wait for 2 months but then there might be a problem with the blood so they will not operate and there will be a longer delay.

Also be aware that in a small number of cases something goes wrong with robotic surgery so the medical team shifts to normal open surgery.

The medical team might prefer robotic because it can be faster and less work.

You need to find out how robotic surgery benefits you that you would want to wait 2 months.

For me the best thing would be to get it out in one week, no doubt about it. It is great this option is available.

I hope you are finding the strength you need to deal with this.  

icemantoo's picture
icemantoo
Posts: 3286
Joined: Jan 2010

Supersum gave you a lot of food for thought. If it were 2 or 3 cm I would want to wait. At 6 cm I would want to get it out ASAP.  Mine was 15 1/2 years ago when there were no robots just laproscopic or open and open was a possable game time decision anyway. Someone once posted that I am so old that DiVinci himself did my surgery.

 

icemantoo

APny's picture
APny
Posts: 1988
Joined: Mar 2014

I'm so sorry you have to be here. I agree with Iceman; I would not wait two months with a 6 cm tumor that has already gone beyond the kindney itself. I had open surgery (the traditional, non-robotic kind) and my recovery was no different than others here who had robotic. My incision is small, but then with a 6 cm tumor that has gone beyond the kidney I would imagine it would be larger. Still, I'd rather have it out as soon as possible. I'm not a physician but T4 usually means it has gone to distant organs. Your husbands' seem to have spread just to the surrounding fat, not other organs. You should question that staging but then until pathology is done they can't tell for certain to the best of my knowledge. A second opinon would not be a bad idea, preferably by someone with lots of experience with kidney cancer. All the very best to you and your husband. It's a very difficult time. I feel for both of you.

Wehavenotimeatall
Posts: 489
Joined: Aug 2017

 Agree with  our esteemed experts .. at 6 cm you want it out now.. the surgery will be tougher but I would not wait two months

Something doesn’t add up if the doctor is telling you not to worry but there is spread beyond the kidney

 

Which country are you in 

Please try not to panic there are lots of treatments to try I know that is easy to say but right now we need to focus on getting the best suchessfor the surgery and then plan your next step.

 We are here any time you need help  and support please lean on us and will try to help you as much as we can 

Annie

todd121's picture
todd121
Posts: 1427
Joined: Dec 2012

Just to be different, I'd wait. No, seriously. I'd wait. Something doesn't add up. T4 doesn't make much sense for a single, 6cm tumor. T4 means metastatic disease, usually more than one tumor. I't possible for a single tumor to be T4, but it's not at all common.

These tumors grow very slow.

On the other hand, when I had mine, I wanted it out ASAP. Mine was between 6-7cm too.

It would seem they could move you up if they really wanted to? Is there anywhere else you can go to get an earlier date on the robotic surgery?

They want to do a radical nephrectomy? Is that correct? It means they want to remove the entire kidney? Are you sure there's no possibility of a partial nephrectomy? You might consider another opinion at another hospital if at all possible. Usually they have spots for situations like this and will work you in within 24-48 hours if you call and ask/explain. Your best opinion will come from a urologic oncologist with experience in robotic laparascopy. These can usually be found at university medical schools, cancer centers, and better hospitals. If you can get an opinion of a medical oncologist on what to do, that would be worthwhile too (if he's really T4, which means there is metastatic disease present).

Knowing what I know now, I would've been ok with waiting 2 months, but not longer.

What kind of specialist are you seeing? A regular urologist? (This is a surgeon who specializes in urological surgeries like kidney, bladder, etc.). A urologic oncologist is a urologist with training in masses of the kidney and how to treat them. They have extra training. For metastatic cancer, you want to see a medical oncologist. These people are not surgeons, they are internists usually that studied hematology and oncology and know how to treat systemic disease and will refer to surgeons and other specialists as needed. Hoping this terminology helps you.

Can you ask why they are saying it's T4?

Best to you,

Todd

JohnThebuilder
Posts: 2
Joined: Apr 2018

Thank you so much for your replies,

Regarding my country : we are Moroccans but working and living here in Qatar

The doctor prefers the robot because he said "It's more acurate and recovery time is less". I'm also confused about T4 , because in that stage the tumor would have been spreed to other organs.

Update :

we went to see another doctor, we have been told he is the best doctor in Qatar. so he basically prefer to wait for the robotic procedure.

He told us that the tumor doesn't look malignat , also It's growing to the side of the kidney.

and he doesn't think the tumor to be T4, as there is no symptoms (Blood in urine, back pain ....)

But I still think we should remove it as soon as possible , so we will consult other doctors

 

Thnx

kiwi68's picture
kiwi68
Posts: 110
Joined: Oct 2017

When you say non robotic surgery, did the surgeon say that he would be doing it laproscopically or by hand as an open surgery?   The laproscopic surgery can be done by hand or with the assistance of a robot.   Open surgery is done by hand. 

My surgeon did laproscopic surgery by hand because that is how he was taught and he is one of the best at it and my operation and recovery were text book.   The advantage of the laproscopic over the open is 5 small scarss from 1.2cm to 0.3 cm.   With the open you have a large wound about 15 cm on the side of removal that can develop a flank bulge (a non fixable large bulge that looks like a hernia - can be as big as a football - I don't know how common they are ).  Open can also create more nerve damage to skin and muscles in that area.  Recovery is longer because of the size of the wound.

With the laproscopic surgery either done by hand or robot assist it is still possible that it turns into an open surgery - because of the position of the tumour, undetected involvement etc. 

There is also another terminology which is that it is a partial nephrectomy or a full.   Partial means the tumour and surrounding tissue are taken and the rest of the kidney is left.  Full means the whole kidney is removed.  This will be up to the surgeon on the day and what is found on opening, though scans can give a good indication of what will planned.   With a partial you need to be careful of bleeding a little bit more after the operation but it isn't significant a worry and the upside is you retain kidney function that would be lost if the whole kidney is taken. 

I attended a private hospital for my surgery, I could have gone to a public hospital with the same surgeon, but I would have waited longer.  Despite being non robotic, laproscopic nephrectomy still requires special equipment required in the oeprating theatre and the wait was longer for the theatre that was equipped at the public hopsital.  I had private insurance so it wasn't a hard descision. 

To summarise: 

Open Full Nephrectom - large scar 15cm - entire kidney removed

Open Partial Nephrectomy - large scar 15cm - part of kidney removed 

Manual Partial Nephrectomy Laproscopically - approx 5 small wounds - part of kidney removed

Manual Full Nephrectomy - approx 5 small wounds - full kindey removed 

Robotic Partial Nephrectomy Lapraoscopically - approx 5 small wounds part of kidney removed

Robotic Full Nephrectomy Laprascpically - approx 5 small wounds part of kidney removed 

You can google hand assisted nephrectomy or DaVinci robot for nephrectomy.   I didn't see any advantage to having a robot do the work - it is just how the tools are manipulated inside to do the cutting and removal of tissue and then suturing/cauturizing.   I would rather a surgeon who is skilled with their own hands and any tools he is using (robot or manual tools).   

If the surgeon does a fair few manual nephrectomies then I would be inclined not to wait for the robot part.   If it the choice between an open wound and laprascopic I might be tempted to wait, but ultimately think I might go ahead anyway. 

 

 

todd121's picture
todd121
Posts: 1427
Joined: Dec 2012

Everything comes with slight variations. I had the robotic laparascopic radical nephrectomy using davinci. I'm pretty sure I had 7 wounds. I found several 1" wounds as annoying as one 7" wound. Lol. Actually, one of mine was about 6" because the surgeon decided he wanted to get the kidney out in one piece because my tumor was in a position that made cutting the kidney in pieces for removal not practical.

Then I had another laparascopic sugery for my adrenal gland 2 years later. Between those two surgeries and my appendectomy and a hernia repair, I have approximately 20 scars on the right side of my abdomen.

It's ok, though. I'm glad to be alive. Scars are good. Much better than dead.

My surgeons did such a good job. The only problem I had was on the second surgery I had an allergic reaction to the glue so my wounds didn't heal for a long time. That was annoying. The first time I had the glue it was no problem. Second time was terrible.

Best wishes,

Todd

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