Was suggested kidney removal for tumor. Can the organ be saved?

Hello,

Welcome to icliniq.com.

It looks like a large tumor in the left kidney. The reports (attachment removed to protect patient identity) show that the disease is localized and not spread to other parts. The only curative treatment for this tumor is surgery (removal of affected kidney along with the whole tumor). It is difficult to save the kidney because of the large tumor size, but the surgeon will review the CT scan films with the radiologist to decide finally regarding any chance of saving the kidney.

After surgery (removal of the tumor), the pathological report will be available, which will show the type of tumor and pathological stage. That will guide us whether further treatment is needed or not. You have not attached kidney function test or liver function test, serum chemistry, LDH (lactate dehydrogenase), alkaline phosphate blood test reports so that I can tell you whether further tests are needed or not, like isotope bone scan, etc.

After surgery usually prognosis is good depending on the pathological report.

Hello,

Welcome back to icliniq.com.

I have gone through the reports. They are almost normal. I am very much hopeful that the bone scan will be normal. I appreciate your decision to go for surgery on Monday. The earlier, the better. After surgery, the histopathological report will guide us for further follow-up and any possible treatment. It will also show us the type of tumor, pathological stage, and prognostic factors. There are still some slim chances of saving a kidney by removing only the partial kidney. But more chances are that the whole kidney will be removed. That is a pure surgical decision. But nothing to worry about if you do not have hypertension and diabetes. That can put an extra burden on the kidneys. One can live with one kidney typically for long years. I have had patients on follow-up for the last 15 years with one kidney after their kidney was removed because of the tumor. They are doing fine.

After surgery, you have to take some precautions lifelong like:

1. Stay hydrated always. Drink plenty of water during hot weather.
2. Keep a regular follow-up every three months for two years, then six-monthly. Monitor KFT electrolytes, LDH, ALP, etc., occasionally. Abdominal scans need to be done six-monthly or yearly for a few years, depending on the histopathological report, which will show how aggressive the tumor is.
3. Do exercise daily (to prevent diabetes, hypertension, obesity and improve blood circulation to the whole body. Just a brisk walk for 45 minutes is acceptable.
4. Avoid some medicines which can harm kidneys most painkillers. Also, avoid herbal medicine.

After the bone scan, revert to me again and anytime in the future.

Hello,

Welcome back to icliniq.com.

I am a medical oncologist. So, once we diagnose the patient with a kidney tumor, we refer him to a surgical oncologist for surgery. He will investigate and assess the patient if he is fit for surgery or not and decide about partial or whole kidney removal. It depends on many factors:

Usually ideal indication for partial removal of the kidney (also called nephron-sparing surgery) is: If the tumor size is less than 4 cm. Still, some surgeons may remove even up to less than 7 cm. It also depends on other factors (peripheral vs. central, exophytic vs. endophytic).

In some cases, we need to preserve the function of the kidneys. For example, if there is a pre-existing disease of the other kidney like chronic kidney infections, some vascular kidney disease, long-standing diabetes, and poor kidney function. So, the whole kidney cannot be removed. We must save the kidney. In this case, I will recommend the removal of the entire kidney because the tumor size is large. So, if we remove only half, there is an increased risk of recurrence than total kidney removal.

Hello,

Welcome back to icliniq.com,

Thanks for sharing histopathology reports. I have seen them (attachment removed to protect the patient's identity). The tumor was removed successfully, and it was limited to the left kidney only. The pathological subtype found is clear cell type Kidney cancer (which is better than other kidney cancers ). They have removed the whole tumor, including nearby lymph nodes. All lymph nodes resected are free of Tumour invasion. It looks like a stage 2 Renal Cell cancer (clear cell type). Regarding further management, for many decades, the only treatment for this kind of localized tumor was surgical excision of cancer along with kidney (nephrectomy), which has been done already.

But according to the latest international treatment guidelines 2017, some medicine (target therapy) is recommended after surgery for upto one year, but only for those at high risk for recurrence. According to histopathology details, he is not in the high-risk group. So I do not think there is a need for further treatment now. But, he must follow up regularly every three months with a medical oncologist or surgical oncologist. As he can examine him physically, review his surgical details, and all scans and lab tests. So for me little challenging to give a final opinion without clinical examination, etc. It is better to discuss any role of adjuvant treatment (after surgery treatment).