Active surveillance (AS)
Active surveillance is the least invasive treatment for small, localized renal masses. Your healthcare provider will help you decide if this is a good choice for you.
For some patients surgery is never needed. Your provider will evaluate your preferences, tumor factors and likely outcomes to see if AS is a good treatment option for you. Tumor factors will include size, stage and growth progression.
The goals of AS are to stop the spread of cancer, maintain kidney function and avoid potential side effects of treatment. There are three tracks for surveillance treatment:
• More Intense AS - You will visit with your provider about every three months for tests and cross-sectional imaging, such as CT scans.
• Less Intense AS - You will see your provider about every six months for tests and imaging. Tests may be both abdominal ultrasound and cross sectional imaging.
• Expectant management (observation) - You will see your provider about every 12 months. Ultrasound will be used more often than other types of imaging procedures.
Partial nephrectomy and radical nephrectomy
Nephrectomy is a surgical procedure to remove all or part of the kidney. There are two types of nephrectomy for a diseased kidney partial and radical. In a partial nephrectomy, the doctor removes the tumor or diseased part of your kidney and leaves the healthy part. Partial nephrectomy is recommended for localized renal masses and can also be done for larger tumors. When the tumor is removed, a biopsy can be done to tell whether it is cancerous or shows sign of advancing.
In a radical nephrectomy, the entire kidney is removed. A radical nephrectomy is recommended if your renal mass is very large or located near critical structures such as the blood supply to the kidney.
Laparoscopy, or robotic surgery, can be done for both types of nephrectomy instead of open surgery. During open surgery, your surgeon will make a large incision (cut) in your abdomen. During laparoscopy, your surgeon will make very small cuts in your abdomen and use a camera and long, stick-like instruments.
If your lymph nodes are affected, your surgeon will examine the node for staging and prognosis. If your adrenal glands are affected, your doctor will most likely remove the glands.
If your tumor is small (a T1a mass less than 4 cm in size), your surgeon may consider ablation. Ablation destroys the tumor with extreme heat or cold.
- Cryoablation (cold ablation) is when very cold gases are passed through a probe that destroys the tumor cells.
- Radiofrequency ablation (hot ablation) is when a thin, needle-like probe is placed through the skin to reach the tumor. Other methods such as microwave or laser ablation also may be performed. Once it is in place, an electric current is passed through the tip of the probe. This heats the tumor and destroys the cells. The probe is guided by ultrasound or CT scans.
Before ablation is done, your doctor will do a biopsy. This will help with treatment decisions. Ablation can be done by laparoscopy or by a percutaneous approach (with a needle).
It is well suited for small renal masses those less than 3 cm. It also helps to preserve renal function and spare the kidney. The percutaneous method is better for some small renal masses because the procedure time is shorter, recovery is quicker and there is less need for pain medication.
Patients with a localized renal mass should have a urologist involved with their care. A urologist will help coordinate evaluation, counseling and management. The urologist should be part of a multidisciplinary team so that all aspects of your care are considered. Your care team might include a radiologist, urologist, neurologist, a pathologist and a medical oncologist.
Counseling would include explanations of the risks and benefits of the treatment plan and possible clinical outcomes. The best treatment plan includes your own preferences, physical condition, other illnesses, outlook and lifestyle. Decisions should include plans for the short and long term.
Genetic counseling should be offered for tumors with a familial history. There are several renal masses that are found to run in families. Patients diagnosed at the age of 46 years or younger should strongly consider genetic counseling. Ask your healthcare provider if you would benefit from genetic counseling.