Re­moval is best op­tion for large tu­mour in­side kid­ney

The Western Star - - LIFE - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGood­[email protected]­nell.edu or re­quest an or­der form of avail­able health newslette

DEAR DR. ROACH: I am 62 years of age and in ex­cel­lent health. I run or hike 3 or more miles on most days, road bike, swim and weight train. I eat sen­si­bly, and I don’t drink, smoke or take drugs. I don’t drink cof­fee or even take as­pirin for pain. My last phys­i­cal exam showed no prob­lems, and my blood and urine tests were fine.

Re­cently, I was di­ag­nosed with a small tu­mour in­side my right kid­ney. It’s about a 2.5 cm solid mass with no rough edges at this time. The MRI showed “a 2.4 cm mildly en­hanc­ing solid mass con­cern­ing for a re­nal neo­plasm.” It also showed that the left kid­ney has a sin­gle 1.2 cm cor­ti­cal cyst over its up­per pole as­pect. Please ex­plain what this means.

The op­tions for treat­ment are to com­pletely re­move the kid­ney and see if it is can­cer­ous or just mon­i­tor the tu­mour and see if it con­tin­ues to grow and re­move later. The doc­tor said the whole kid­ney has to be re­moved, be­cause of the central lo­ca­tion of the tu­mour. The doc­tor also said a biopsy is not a good idea where the mass is lo­cated for fear of re­leas­ing can­cer­ous cells within the kid­ney that could move quickly through­out the body. Re­moval is a dras­tic mea­sure, no doubt, to test for kid­ney can­cer. Should I just mon­i­tor and wait to see what the tu­mour does or op­er­ate and have the kid­ney re­moved. What med­i­cal ac­tion do you sug­gest that I do? — B.J.R.

AN­SWER: I am sorry to hear about your kid­ney tu­mour. A soli­tary kid­ney mass in a man in his 60s is al­ways sus­pi­cious for kid­ney can­cer. A 2.4 cm tu­mour is large enough to pro­voke se­ri­ous con­cern: In a re­cent study, in peo­ple who had their tu­mours re­moved, 83 per­cent of tu­mours that size were kid­ney can­cer.

Be­cause of the lo­ca­tion, a par­tial re­moval of just the mass is im­pos­si­ble, so the choice be­tween watching and wait­ing ver­sus tak­ing the whole tu­mour out should take into con­sid­er­a­tion the very high like­li­hood that this is can­cer. Kid­ney can­cer can spread to other or­gans. If you were my pa­tient, I likely would ad­vise surgery. If you were not a good risk for surgery (say, in your 80s with multiple med­i­cal prob­lems), then I might con­sider watch­ful wait­ing. In your case, I think go­ing for surgery is the wiser course. Be­ing so healthy will make your treat­ment much less risky.

DEAR DR. ROACH: I have se­vere lower back pain and can’t stand up straight or walk very well. I saw a back spe­cial­ist, and he took X-rays and re­viewed an MRI. He in­formed me noth­ing could be done for me be­cause I have dif­fuse id­io­pathic skele­tal hy­per­os­to­sis (DISH). I would like to know what this is and why noth­ing can be done for me. — Anon.

AN­SWER: DISH is essen­tially a dis­ease of bone spurs. The lig­a­ments and their at­tach­ments to bone them­selves be­come cal­ci­fied and bone­like. The cause is un­known. Symp­toms are com­monly back pain (more of­ten, mid­dle or up­per back, not the lower back pain you have), but pain also may oc­cur in the neck. Prob­lems with walk­ing are not com­mon, but can hap­pen if a nerve is be­ing com­pressed.

Surgery is not a usual treat­ment for DISH. It is oc­ca­sion­ally nec­es­sary if the bone spurs press on nerves or if the bone spurs are so large that they in­ter­fere with eat­ing. That doesn’t mean noth­ing can be done for you. Phys­i­cal ther­apy may be very ben­e­fi­cial; ju­di­cious pain med­i­ca­tion and reg­u­lar gen­tle ex­er­cise are the other ef­fec­tive treat­ments.

If the dif­fi­culty stand­ing straight and walk­ing per­sist, you should get re-eval­u­ated.

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