Maybe you had an Ultrasound or a CT scan for an issue unrelated to your kidneys, but the radiologist saw something on one of them. A spot. A mass. 

Your mind races. What is it? What if it's cancer? What happens next?

In this blog post, Dr. Mark Silva discusses what to keep in mind.

As with all content on our blog, the following is educational, not medical advice. Always consult your medical provider about your health. 

Kidney cancer at a glance

According to the American Cancer Society, kidney cancer ranks among the 10 most common cancers for both men and women in the United States, making up approximately 4% to 5% of all cancer cases. 

Most people with kidney cancer are older (65 is the average age of diagnosis). It’s uncommon for anyone under 45 to have this type of cancer.

While the rate of kidney cancer diagnosis has been on the rise in recent years, the rate of death from kidney cancer has been declining. We get into why in the next section.

Most kidney cancer is found by accident and caught in the early stages.

Currently, there's no screening for kidney cancer. 

Dr. Silva explains, "There are clinical trials studying different tests that could be used to screen for kidney cancer, but they are still in early stages and unreliable.  It is exciting science that will be used in the future of cancer screening, but just not there yet for kidney masses. " 

As such, most kidney masses are incidental findings, meaning they happen by accident. For example, a person might fall off a bike and receive a CT scan, and the radiologist reviewing the scan sees something on the kidney. 

Dr. Silva quickly points out that seeing something on a kidney doesn't automatically mean cancer. The words the radiologist uses in the report matter. 

Dr. Silva says, "Are they commenting that it's a simple cyst? Are they commenting that there's thickening around the kidney? Or are they actually using keywords like solid, enhancing, or lesion? If it's a simple cyst or an infection, it's nothing I would worry about. If they say it's a complex-appearing cyst, or if it's a solid-appearing kidney tumor or mass, then that's something that does require prompt urological follow-up and care."

The good news is that many kidney cancers are found early, when the cancer is contained in the kidney and is most treatable.

"Kidney cancer, generally speaking, is found most of the time by accident when it's still in an early stage," Dr. Silva says. “We call these Small Renal Masses.”

What if kidney cancer is suspected?

Dr. Silva says your urologist will review your imaging with you and explain what they're seeing. If the initial imaging doesn't provide enough information, your doctor will likely order an additional CT scan and/or an MRI to better characterize it. 

Urologists assess whether something looks like kidney cancer based on the mass's imaging characteristics and how it lights up when IV contrast is used for your study. 

"For the majority of patients, I would say imaging itself is enough to give us an idea of how we should intervene in the next step in management," Dr. Silva explains. "We can usually infer, about 80% of the time, whether or not we feel like this solid-appearing tumor represents an actual kidney cancer or not."

This is why rushing every patient in for a biopsy is unnecessary. 

Dr. Silva explains, "Oftentimes, we know what we're seeing, and we want to make sure that our patients get the best care while minimizing additional procedures that may cause unnecessary complications." 

From there, your doctor will assess your overall health and kidney function, and they might order additional lab work or imaging to make sure the cancer is only in the kidney.

An overview of treatment protocols for kidney cancer

Treatment depends on the size and location of the kidney mass as well as the patient themselves. Dr. Silva says, "We'll take a good measurement of the mass and characterize it.  When it comes to treatment, though, that’s a discussion."  Treatment of these masses balances the threat of the mass, the age of the patient and the goals of care.

A small renal mass can be managed with active surveillance, which is a monitoring process with imaging at a regular interval. This would ensure that the mass stays small and doesn't grow significantly larger. If it does grow, your urologist would be able to catch it and intervene.

Other potential treatments—depending on the size, the tumor's location, and your urologist's judgment—include the following: 

Thermal ablation

Thermal ablation is a minimally invasive procedure that an interventional radiologist performs by inserting a needle into the tumor to freeze it off or burn it off. 

Dr. Silva says, "This can work for select patients who can't undergo surgery. While it is effective, it does have a higher retreatment rate in the future compared to undergoing surgery."

Surgery: Partial or radical nephrectomy

Dr. Silva says the mainstay for certain patients with contained kidney cancer may be surgery. 

Your urologist will determine whether your tumor is more amenable to a partial nephrectomy (removing just the tumor) or a radical nephrectomy (removing the entire kidney) both of which are now routinely done robotically.

"A partial nephrectomy is a robotic surgery that is a specialty among urologists," Dr. Silva says. "It is one that's done with several tiny little incisions, about the size of a pen. Basically, we can use these tiny incisions and robotic instruments to visualize the tumor on the kidney and peel it off while potentially saving the vast majority of that kidney. It is a more technically challenging procedure, but in the right hands with a robotically-trained surgeon, you can have a very good outcome, and you can have a very quick, fast recovery course."

With radical nephrectomies, Dr. Silva says, reassuring the patient is essential. 

“Adjusting to the idea of living with one kidney can be challenging, but patients should know that a single kidney is fully capable of supporting a long, healthy, and active life. This is why living donor kidney transplantation is possible, and why patients who receive just one kidney can discontinue dialysis. Some individuals are even born with one kidney and live entirely normal lives without any limitations. The human body has a remarkable ability to adapt, and most people with a single kidney do extremely well.”

Dr. Silva says you would treat your one kidney the same way if you had two kidneys. This includes following a heart-healthy, low-salt diet filled with plenty of fruits and vegetables and getting lots of daily exercise. 

What happens post-surgery?

After your partial or radical nephrectomy, your urologist will review the pathology report with you line by line, describing the tumor, explaining how to characterize it, and alerting you if any higher-risk features are present. 

Based on what the pathology report shows, for less aggressive or lower-risk tumors, the protocol is to routinely monitor with additional CT scans or ultrasounds. 

For patients with higher-risk tumors that may have a higher chance of coming back, the protocol might involve a referral to medical oncology for immunotherapy. 

Dr. Silva notes, however, that the vast majority of kidney cancers, after surgical treatment, are usually treated with close surveillance.

Concerned about the results of an imaging scan? See a urologist.

Remember, just because your radiologist spotted something on one of your kidneys, that doesn't necessarily mean it's cancer. Talk to a urologist. 

At Greater Boston Urology, we have care centers throughout Massachusetts, including the Cape, and our newest centers in Attleboro and Leominster. Request an appointment now.