April 9, 2010
Dear Mayo Clinic:
I had a radical nephrectomy of my left kidney six months ago, which showed stage I renal cell carcinoma. My doctor recommends I follow up with a CT scan of the chest and abdomen, along with blood work every six months. Is this aggressive enough? How serious is this disease, and what are the chances it will return or show up elsewhere?
It's difficult to specifically determine if the follow-up your doctor has recommended is best for your situation without knowing some additional information. Generally the higher a person's risk of recurrence, the more follow-up is needed. Several factors have an impact on the likelihood of renal cell carcinoma recurrence, including the stage and grade of the tumor. Fortunately, the majority of people who have this type of kidney cancer are cured with surgery alone.
Stage I renal cell carcinoma, such as yours, is confined to the kidney with no evidence of spread to other areas. At this stage, kidney cancer rarely causes signs or symptoms. Most cases are discovered incidentally when people have an imaging exam performed for another reason.
Stage is an important factor for determining the prognosis of kidney cancer and the follow-up required. The lower the stage, the better the long-term outlook. In later stages, when a person begins to develop signs and symptoms — blood in the urine, side pain, abdominal pain or fevers, for example — it's more likely that the cancer has spread beyond the kidney, making cure less likely.
The grade of a tumor also has to be considered when determining appropriate follow-up. Grade is different from stage. Stage involves how far the tumor has grown when it's discovered. Grade characterizes how aggressive the cancer cells appear when a pathologist examines a sample of the tumor. Grade for renal cell carcinoma ranges from 1 (least aggressive) to 4 (most aggressive). The likelihood of renal cell carcinoma being effectively treated with surgery is related to grade. The lower the grade, the more likely that an individual will be cured with surgery.
In addition to grade and stage, the pathologist can identify other unique features of the tumor that also affect the frequency of follow-up tests needed. The specific testing required and the interval of testing depend on these multiple features that determine the likelihood of recurrence for a patient. Mayo Clinic urologists have developed tools to calculate the risk of recurrence based on all these features and tailor the follow-up regimen appropriately.
The type of surgical treatment you had, radical nephrectomy, involves removing the kidney, a border of healthy tissue around the kidney, and adjacent lymph nodes. That procedure is usually performed for larger tumors. In another surgical option, partial nephrectomy, the surgeon removes the tumor and a small margin of healthy tissue that surrounds it, rather than removing the entire kidney. Partial nephrectomy is generally preferred when the tumor characteristics allow for it.
The cure rates for both partial and radical nephrectomy are equally good, and most people don't require additional treatment following surgery for kidney cancer. In addition, after effective treatment for cancer in one kidney, the likelihood of developing cancer in the other kidney is also low — approximately 2 to 3 percent.
If you're concerned about your follow-up schedule, talk to your doctor. Review the grade and stage of your tumor, and ask about other factors that may be playing a role in your risk of recurrence. This information can help determine the right follow-up regimen for you.
— Bradley Leibovich, M.D., Urology, Mayo Clinic, Rochester, Minn.