This is about a tumor in the kidney case as follows.
Before ten days, the patient found bloodstain in the urine. No pain, no other symptoms. On the next day, after drinking two glasses of water, he developed pain in the lower abdomen and back. Got an ultrasound done. Ultrasound showed a tumor in the left kidney (report attached). The following day, we got a CT scan done, and it showed a big mass arising from the lower pole of the left kidney of size 8.8(AP)*6.9(TR)*7.4(SI) cm, and the doctor suggested surgery which involves removal of the kidney to save from spreading. Let me know if the kidney can be saved and the disease eradicated and controlled from spreading further.
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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.
Thanks for your detailed reply. Please find attached LFT/KFT/alkaline and renal DTPA reports. A bone scan has also been done today. The report is expected by tomorrow morning. The doctor has advised surgery on Monday. I have two questions - a) Is there any remote chance of saving the kidneythrough some miraculous medical advances? b) What is the life expectancy of the survivor with one kidney at age 43? Are there any 'special' medical/lifestyle advice/precautions to be taken to maintain surviving kidneys in good health and protected from the same thing to reoccur?
Thank you and regards.
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:
After the bone scan, revert to me again and anytime in the future.
Thank you doctor,
Here is the renal bone scan report. Please tell me that when you say slim chances of saving a kidney is a purely surgical decision, how and based on what factors it will be decided as we are done with all tests and scheduled for surgery on Monday. Let me put it this way. If you were the doctor to operate what would be your decision or how will you decide if it is to be decided on operation day? Tell me what would you do, if you were the doctor? Also, please note that we are ready to go to any extent if there are any chances of saving the organ. Awaiting your response ASAP. Thanks and regards.
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
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