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Urinary Tract Cancers

Diagnosis and treatment of a kidney tumor.

12/02/2002

Question:

Diagnosis and treatment of a kidney tumor.

My 84-year old mother has the following pre-conditions: mild hypertension adequately treated with drugs, pernicious anemia treated with monthly B-12 shots, osteoporosis treated with Fosomax. She is of Asian-Indian decent, is a non-smoker, exercises regularly, has a healthy diet, not overweight, drinks one glass of alcohol daily, and is in general good mental and physical health. Her PCP predicts my mother has a good 10 years of life ahead of her.

This month she was diagnosed with a 5.7 cm round tumor on her left kidney discovered by accident during an ultra sound, and later in a CT scan. The CT scan does not show any spread to the other kidney, and her chest X-ray is clear of any spread. She has had no symptoms besides a slight bloating of her abdomen, which her uro-oncologist thinks is not related. A recent lactose-free diet has reduced her bloating by 50%, but still remains present.

Her uro-oncologist has decided not to do a biopsy because a negative result is usually not conclusive, and also because there is risk of spreading the cancer cells along the needle path if indeed the tumor is cancerous. He recommends a nephrectomy to remove the infected kidney. He says that removing only the tumor in order to save the infected kidney is not an option given that there is usually bleeding in the saved kidney, and because humans typically need only one healthy kidney. The following are my questions regarding her diagnosis, and treatment, which I will also be asking during a face-to-face second opinion with another uro-oncologist in a different hospital:

1. Is it common not to do a biopsy to determine if a tumor is benign or not for such conditions?

2. Given that we do not know whether the tumor is benign or not, and the risks of surgery at her advanced age, is a nephrectomy a good choice? I am concerned that surgery is more appropriate for a younger person.

3. An alternate approach that has been suggested by a knowledgeable person (but who is not a uro-oncologist), is to watch the growth of the tumor over the next three months to see if it grows rapidly. If it does not grow, it means it is benign and probably should be left alone. In other words, my mother may very well die "with" the tumor, rather than "of it". Does this reasoning apply to her case, or should a tumor of this size be regarded as pre-cancerous, and therefore removed through nephrectomy?

4. The uro-oncologist has not informed me if he will do a laparoscopy or not. If we proceed with surgery, is a laparoscopy the recommended approach for my mother’s condition?

5. Are there any prognosis and after-effects studies of a radical nephrectomy on older people? If there are, can you please point them to me?

6. Is the pernicious anemia and bloating related to the kidney tumor?

Thanks! Look forward to your answers.

Answer:

Biopsies typically are not done in that the diagnosis can usually be made by the radiographic studies such as a CT. Also a negative biopsy does not exclude the presence of a malignancy. Nephrectomy is the treatment of choice based on the information you provided. These tumors do not respond to chemotherapy or radiation therapy. I would not suggest watching the tumor. Some grow slowly and others rapidly but the chance of metastasis or spread of the tumor is significant. It therefore should be removed. Laparoscopic nephrectomy is an option and this should be discussed with the urologist caring for your mother. Assuming her other kidney is fine, she should do well after recovering from the operative procedure. To my knowledge, pernicious anemia and bloating are not related to the kidney tumor. I hope this information is helpful to you.

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Go to the Urinary Tract Cancers health topic, where you can:

Response by:

Martin I Resnick, MD Martin I Resnick, MD
Formerly, Professor of Urology
School of Medicine
Case Western Reserve University