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

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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.

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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.

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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 but some surgeons may remove even up to less than 7 cm. It also depends on many other factors (peripheral vs central, exophytic vs endophytic).

In some cases, we need to preserve the function of the kidneys. So, the whole kidney cannot be removed. We must save the kidney. 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. Personally, in this case, I will recommend removal of whole kidney because the tumor size is large. So, if we remove only half there is increased risk of recurrence compared to whole kidney removal.

For more information consult a medical oncologist online --> https://www.icliniq.com/ask-a-doctor-online/medical-oncologist

# Thanks for sharing histopath reports I have seen the histopathological report . The tumour was removed successfully and it was limited to left kidney only and the pathological subtype found is clear cell type Kidney cancer ( which is better than other type of kidney cancers ) . THey have removed whole tumour including near by lymph nodes . All lymph nodes resected are free of Tumour invasion . It looks a stage 2 Renal Cell cancer ( clear cell type )
Regarding further management since many decades the only treatment for this kind of localized tumour was surgical excision of the tumour along with kidney ( Nephrectomy ) which has been done already
But according to latest international treatment guidelines 2017 some medicine ( target therapy ) is recommended after surgery for upto one year period But only for those who are at high risk for recurrence .
According to Histopath details he is not in the high risk group . So i don't think there is need for further treatment now But he must follow up regularly every three months to Medical Oncologist or Surgical Oncologist
It is better to discuss with the Medical Oncologist regarding any role of adjuvant treatment ( after surgery treatment )
As he can examine him physically , review his surgical details , and all scans and lab tests . So for me little difficult to give final opinion with out clinical examination etc

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