Experts In Vasectomy and Urological Treatments

Dr. Snoy is a general urologist. In addition to vasectomies he also treats:
• Bladder control
• Overactive bladder
• Bladder cancer
• Urinary incontinence
• Kidney stones
• Prostate disorders
• Prostate cancer
• Erectile dysfunction

Renal Mass Observation

Written by: Dr. Fredrick Snoy

For decades, solid renal masses have been considered to be kidney cancers, usually renal cell carcinomas, and have been treated by surgical removal. In the last 10 to 15 years we have gained a better knowledge of kidney cancers and renal tumors, including clearer ideas about the numbers of benign tumors (a small percent), tumor behavior and improved medical therapy for advanced renal tumors have become available.  This setting has allowed urologists to consider increased use of active surveillance or watchful waiting for smaller renal tumors.  The trick of course is to not intervene on tumors that are not likely to spread or metastasize, while to move ahead on kidney cancers that are bound to be problematic and have dangerous outcomes.

 
Unfortunately there are no clear guidelines to differentiate between kidney cancers that will behave nicely, perhaps remaining stable for years, and those that will grow and spread elsewhere.  Generally, active surveillance is reserved for tumors that are less than 3cm in size. Renal tumors larger than 4 cm are usually removed by most urologists. Other factors come into play such as the patient’s age, health status otherwise, potential for surgical intervention and overall life expectancy.  Longevity within the family is often part of the discussion as well as patient wishes and attitudes toward treatment.  Tumor related anxiety, is an important factor.  If one lies awake at night worried about the tumor, moving ahead with removal of the presumed kidney cancer may be the best course.

 
Research including biopsy and development of genetic testing and tumor markers  for kidney cancers may in the future help doctors to more accurately predict which renal tumors will be bad actors and which will not. These studies are ongoing. Fortunately many of these smaller kidney tumors can be addressed by methods other than standard surgery.  Cryoablation (freezing treatments) and radioablation (heating treatments) can often kill the kidney cancer by methods much less invasive that nephrectomy (kidney removal) or (partial nephrectomy) removal of the tumor and minimal benign tissue around it.  These approaches my sway a patient’s decision more in favor of intervention than active surveillance.  Tumor location is an important factor in using some of these minimally invasive surgery or approaches or partial nephrectomy.  Tumors at the edges of the kidney maybe much more accessible, while central kidney cancers, may not be approachable by these methods.

 

 
If you would like to discuss these options, review of scans and a discussion of these issues can be had by scheduling a consultation appointment. Please call (505) 872-4091, for further information.