Renal Masses

Renal masses – What a patient needs to know.

Renal Mass Specialists:     Make an Appointment

• Wayne C. Waltzer, M.D., F.A.C.S.
• John Fitzgerald MD,MSCI
• Massimiliano Spaliviero, MD

1. Not All Kidney Tumors are Malignant.

• Approximately 15% of newly diagnosed localized kidney masses are non-cancerous or benign. These benign lesions occur more frequently the smaller the lesion is.  Unfortunately, benign lesions are often indistinguishable from kidney cancer with modern imaging. However, at times, expert radiologists are able to review a patient's imaging study and make a diagnosis of a benign lesion, saving an individual from unnecessary treatment.

• A percutaneous biopsy performed under expert radiographic guidance and interpreted by experienced pathologists can sometimes provide valuable information to guide treatment decisions in select cases.

• Physicians can use predictive tools that help to separate high risk cancers from tumors that do not pose an immediate risk to patients with competing risks to their health from other medical illnesses.

2. The Goals of Treatment:

1. The primary treatment goal: Cure Cancer - cancer control must never be compromised and surgical resection is the gold standard treatment for patients with kidney tumors. Yet, for some patients, our physicians are able to manage patients with "active surveillance"³- a method where the tumor is watched and if signs of progression are seen, curative treatment is initiated.
2. Secondary treatment goal: Kidney Preservation - years of experience with kidney (aka: nephron) preserving surgery (partial nephrectomy) demonstrates that this approach provides similar cure rates to total nephrectomy and is associated with long-term benefits to overall health. A standardized system to classify features of kidney tumors as they relate to ability to safely perform partial nephrectomy – the R.E.N.A.L Nephrometry Score ⁴ -  is currently used by kidney surgeons all over the globe.  Not only can this tool aid in determining the ability to perform partial nephrectomy, it can quantify the risk of complications following these types of surgery⁵.
3. Tertiary treatment goal: Utilization of Minimally Invasive Surgical Approaches – Often undertaken with the help of a robotic surgical platform, both transperitoneal and retroperitoneal minimally-invasive (laparoscopic / robotic) surgical approaches are currently utilized by our expert kidney surgeons.  These can be performed both to remove the entire kidney (laparoscopic nephrectomy) or in a way to remove the tumor and save the healthy remaining kidney (laparoscopic or robotic partial nephrectomy). Finding the right surgeon may help avoid a large painful incision, albeit traditional open kidney surgery continues to play an important role in management of some patients with large or anatomically complex kidney tumors.

3. Be Prepared During Your Visit.

Here are some questions to pose to your treating physician when you or your family member is diagnosed with a renal mass:

• Understand the characteristics of your mass: size of tumor, clinical stage of tumor, RENAL Nephrometry Score (anatomic complexity score). If your tumor has been resected, be sure to obtain information regarding pathologic stage, grade and histology. Pathology review by expert pathologists at times can make a critical difference in guiding further treatments.
• Why or why not do a biopsy?
• Treatment Options:
  • Active Surveillance - am I a candidate?
  • Medical Therapy - generally reserved for tumors that have spread
  • Renal Mass Ablation (percutaneous cryosurgery) - generally reserved for frail patients whose surgical risks are prohibitive.
  • Surgery
    • Partial nephrectomy: is your surgeon familiar and experienced with kidney preservation techniques? Is he/she comfortable performing partial nephrectomy minimally-invasively, thus accelerating your recovery and minimizing pain?
    • Radical nephrectomy: if radical nephrectomy is offered, be sure to establish that partial nephrectomy is not possible at a more experienced center. If kidney preservation is not possible, can radical nephrectomy be performed with minimally-invasive techniques?
• Risks of treatment: be sure to understand risks associated with each option.