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What Does A Lesion On The Kidney Mean

What You Need To Know

Treatments for Kidney Tumors – Kenneth Nepple, MD

About Kidney Masses

  • Many masses may never need to be removed though evaluation by a qualified physician is the only way to determine this
  • Complex cysts may require further testing
  • Solid masses, especially those that pick up blood are considered malignant until otherwise proven
  • Typically, we follow masses under 2.5cm for further growth before treating

Causes

  • The causes of kidney masses are many and varied

Treatment

  • Hand assisted laparoscopic radical nephrectomy
  • Hand assisted laparoscopic partial nephrectomy
  • Robotic partial nephrectomy

Types Of Liver Cancer

There are two major types of primary liver cancer :

  • Hepatocellular carcinoma :This is the most common type of liver cancer. HCC tumors are three times more common in men than women.
  • Fibrolamellar carcinoma: This is a subtype of HCC, where fibrous bands separate the cells of the tumor. In contrast with hepatocellular carcinoma, fibrolamellar carcinoma is seen more in women than men. And unlike HCC, its risk factors are not known.
  • Cholangiocarcinoma:This is the cancer of the bile duct. With cholangiocarcinoma, malignant liver lesions develop in the branches of the bile duct. These tumors can appear in the bile duct parts that are in the liver, or further down, in parts of the bile duct near the small intestine.

Rarer types of liver cancer include liver angiosarcoma and hepatoblastoma. Cancerous tumors that originate in other parts of the body can spread to the liver. And cancerous tumors that start in the liver can also spread to other parts of the body.

Treatment For Kidney Lesions

The treatment of the kidney lesions may vary, it will depend on the causative factor.

The physician will decide whether the person needs conservative line of treatment or more invasive procedures such as surgery. In malignancy he may require chemotherapy or radiation as the doctor suggests. Hemodialysis may be necessary if the kidney is not functioning.

In addition to the above mode of treatment, certain home remedies and natural cures are valuable for kidney lesions.

  • The herb Hoelen is useful to stop the kidney lesion. It is said to be an immune suppressant.
  • Cut down intake of meat, poultry and fish as they are known to increase the uric acid that forms the kidney stone.
  • Water melon is the best diuretic and helps to increase the urine outflow. You can drink the juice or simply eat sliced watermelon.
  • Uva ursi is an anti inflammatory and antibacterial for kidney. It prevents bleeding if the kidney disease is mild.

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What Are The Causes Of Kidney Lesions

Kidney lesions are commonly caused by cancers, infections, or nephrosis. These lesions are defined as areas of the kidney where anomalous tissues exist. Whether or not the lesions are cancerous or benign, they may be a serious condition and require attention. Symptoms of kidney lesions may include swelling due to water retention, blood in the urine, and lower back pain. A majority of people, however, do not experience any outward symptoms until lesions have been present for a long time, if at all.

Possible causes of kidney spots or kidney lesions are chronic infections, which lead to damage or scarring. This results in the obstruction of the kidneys drainage system and interferes with normal function. Similarly, a kidney spot could be due to inflammation, surgery or any irregularities in kidney-related activities.

Renal cell carcinoma, or hypernephroma, is a common kidney cancer in which lesions and other cancerous cells develop in the tubes of the kidney. These lesions can multiply, grow, and spread until the person feels intense discomfort. If the cancer is detected at an early stage, surgery and other treatments can be deployed to combat it. Unfortunately, this cancer may go without symptoms and remain completely undetected for months or even years and is sometimes only found when its too late.

What Are Kidney Cysts

Brady Urology at Johns Hopkins Hospital: Renal Cell ...

A cyst is a closed pouch or sac filled with air or liquid. Kidneys are bean-shaped organs located in the lower back that help to control the amount of salt and water in the body. They also remove waste products by filtering the blood and making urine.

Inside the kidneys are small working parts called nephrons. Each nephron is made up of a filter and a tube. As blood flows through the kidneys to be filtered, the nephrons remove extra water and waste products, which leave the body as urine.

Simple kidney cysts are usually small round sacs that have a thin wall and are filled with a watery fluid. As people get older, cysts can form on the surface or in the nephrons of the kidneys. They can range in size from a small pea to as large as a grapefruit. Cysts can also grow over time.

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Rare Types Of Kidney Cancer

Rare kidney cancers occur most frequently in children, teenagers, and young adults.

Papillary renal cell carcinoma

  • 15% of all renal cell carcinomas
  • Tumor located in the kidney tubes
  • Type 1 PRCC is more common and grows slowly
  • Type 2 PRCC is more aggressive and grows more quickly

Translocation renal cell carcinoma

  • Accounts for 1% to 5% of all renal cell carcinomas and 20% of childhood caces
  • Tumor located in the kidney
  • In children, TRCC usually grows slowly often without any symptoms
  • In adults, TRCC tends to be agressive and fast-growing

What Causes Simple Kidney Cysts

Kidney cysts occur when the tube of a nephron begins to get bigger and fill with fluid. Researchers don’t know what causes this to occur, but they do know that simple cysts aren’t inherited. It is believed that injury or microscopic blockages in the tubules may lead to the development of some simple kidney cysts.

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Low Density Renal Masses Should Not Be Dismissed As Benign

The guidelines say that if the density of a mass on the kidney is less than 20 Hounsfield units it has a strong likelihood of being a cyst, and that is what most radiologists go by, said Robert G. Uzzo, MD, MBA, FACS, chair of the Department of Surgical Oncology at Fox Chase. In this study, we found a lot of patients who had gotten a scan and were told not to worry because the lesion was likely a cyst. But, in fact, it was cancer.

PHILADELPHIA A new imaging study from researchers at Fox Chase Cancer Center has found that many small renal lesions found accidentally during imaging examinations and classified as benign may actually be cancers.

The guidelines say that if the density of a mass on the kidney is less than 20 Hounsfield units it has a strong likelihood of being a cyst, and that is what most radiologists go by, said Robert G. Uzzo, MD, MBA, FACS, chair of the Department of Surgical Oncology at Fox Chase. In this study, we found a lot of patients who had gotten a scan and were told not to worry because the lesion was likely a cyst. But, in fact, it was cancer.

According to Uzzo, many scans conducted to examine patients for a nonspecific abdominal or gastrointestinal complaint are done without contrast dye. If a lesion is found on the kidney, radiologists will often measure the density of it using HU, which measures the radiodensity of objects. If the lesion is under 20 units, it is designated as a renal cyst, which are largely benign.

How Do I Know If I Have Kidney Cancer

What Is Kidney Cancer and How Is It Treated?

Maybe you’ve had kidney cancer symptoms such as pain in your side, weight loss, or extreme fatigue. Or maybe your doctor has found a lump in your side during a routine exam or a sign of kidney cancer during a test for another disease. Regardless, to confirm a diagnosis of kidney cancer, you will need a thorough physical exam, health history, and tests.

Your doctor will feel your abdomen and side for lumps and check for fever and high blood pressure, among other things. You will also answer questions about your health habits, any past illnesses, and types of treatment. To make a diagnosis of kidney cancer, your doctor will also order one or more tests like these:

Unlike with many other cancers, your doctor may be pretty certain about a diagnosis of kidney cancer without a biopsy. Sometimes, a biopsy will be done to confirm the diagnosis. A doctor may use a needle biopsy to remove a sample of tissue, which is then examined under a microscope for cancer cells. The biopsy may also tell the grade of the cancer — how aggressive the cancer is likely to be. Often the surgeon will simply remove the entire tumor and then have a sample of tissue examined.

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Magnetic Resonance Imaging Scan

MRI scans;may be done when a person cant have the CT contrast dye because they have an allergy to it or they dont have good kidney function. MRI scans may also be done if theres a chance that the cancer has grown into major blood vessels in the abdomen , because they provide a better picture of blood vessels than CT scans. Finally, they may be used to look at abnormal areas in the brain and spinal cord that might be due to cancer spread.

How Are Renal Cysts Treated

Renal cysts generally do not require treatment unless they are causing symptoms or harming kidney function. Treatment options include:

  • Sclerotherapy: Also known as percutaneous alcohol ablation, sclerotherapy involves the insertion of a long needle through the skin and into the cyst under ultrasound guidance. The doctor will drain the cyst and fill it with an alcohol-based solution that causes the tissue to harden and shrink, reducing the chance of recurrence. The procedure is usually performed on an outpatient basis with a local anesthetic.
  • Surgery: For larger cysts, a surgeon will make a small incision and access the cyst with a laparoscope. The surgeon will then drain the cyst and burn or cut away its outer layer. Laparoscopic surgery requires general anesthesia.

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What Happens To Patients With Renal Cell Carcinoma

Prognosis in patients with renal cell carcinoma

In general, the prognosis and prediction of outcomes after treatment for RCC is generally based on tumor-specific factors and patient-specific factors . Based on large studies of patients with RCC, prognostic scoring systems have been developed and validated.

  • Tumor Node Metastasis staging system

  • Memorial Sloan Kettering Cancer Center ; validated by the Cleveland Clinic Foundation

  • UCLA Integrated Staging System

  • Stage Size Grade and Necrosis scoring system for clear cell RCC; emphasis on histologic/pathologic features of clear cell RCC

  • Fuhrman Nuclear Grading System for RCC

Tumor Node Metastasis staging system:

This system is used to give general prognostic information based on the extent of tumor burden . This system is used to evaluate survival up to 5 years post-diagnosis, based on the stage at the time of diagnosis.

For stages I, II, III, and IV the 1, 2, 3, 4 and 5 year survivals are approximately as follows: respectively.

Memorial Sloan Kettering Cancer Center:

This system is perhaps the most widely used and most well validated scheme for prognostic stratification. This system is based on clinical factors and was developed based on outcomes of patients with advanced RCC. The system has also been validated by the Cleveland Clinic Foundation. Five factors are used to estimate survival in patients with advanced disease:

Based on these five factors, 3 risk categories are determined and correlate with survival data.

Table 2.

Types Of Benign Liver Lesions

What Is Kidney Cancer?  Happy Hospital

There are different types of benign liver lesions.

Hepatic Hemangioma

Hepatic hemangioma is the most common type of liver lesion, consisting of clusters of small blood vessels. Around 20% of the general population have hemangiomas. They don’t typically cause symptoms, so they can be left untreated.

But In rare cases, they can cause stomach pain, nausea, and the inability to eat a full meal . Women are more likely to have hemangiomas than men.

Focal Nodular Hyperplasia

This is the second most common type of liver lesion. Like hemangiomas, FNH is seen more in women than men. In 80% of cases, FNH is found in women between the ages of 20 to 50. An FNH lesion can grow bigger or smaller, but regardless of changes to its size, it does not become cancerous.

Benign Hepatic Cyst

This type of lesion contains a clear, bile-like liquid and does not usually cause any symptoms. Although, in rare cases, if the cyst is large, it may cause abdominal pain or nausea, vomiting, and early satiety. Anywhere from 2.5% to 18% of the general population could have benign cysts in their liver.

Hepatic Adenomas

These are uncommon liver lesions that develop predominantly in young women. It can be caused by long term oral contraception use or synthetic testosterone use. Hepatic adenomas can sometimes cause discomfort in the abdomen.

If you have hepatic adenomas, your doctor will likely ask that you stop taking oral contraceptives . Surgery to remove them will probably also be prescribed.

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Symptoms Of Kidney Cancer

In many cases, there are no obvious symptoms at first and kidney cancer may only be found during tests for another condition or reason.

If there are symptoms, they can include:

  • blood in your pee; you may notice your pee is darker than usual or reddish in colour
  • a persistent pain in your lower back or side, just below your ribs
  • a lump or swelling in your side

Kidney Tumor With Suspicion Of Spread

You may have been told that the kidney cancer has spread. This could be to lymph nodes, the lungs, liver, bone, or even the vena cava รข the largest vein in your body.

About 1/3 of patients find that the cancer has spread even without any symptoms.

For those with symptoms, you may have experienced abdominal or back pain, blood in the urine, bone pain, seizures, or even bad headaches. After a full evaluation of the extent of spread a treatment plan should be formulated.

This can get quite complicated and a multidisciplinary team who specialize in kidney cancer would be best to help with this. It is important that an urologist and medical oncologist collaborate in constructing an optimal plan for your care. This multidisciplinary approach is most important for cancers with a high suspicion of spread! This is because today there are numerous options and combinations for patients with metastatic kidney cancer.

These options can include:

  • Surgery – In certain settings, removal of the kidney even when the cancer has already spread has been shown to improve survival. This can often be done laparoscopically so the patient can recover rapidly and promptly receive additional therapy.

  • Immunotherapy – IL-2 can be a good option for some patients and can deliver excellent results for some patients. Interferon-alpha is another option.

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    What Is A Renal Mass And What Is A Localized Renal Tumor

    The word renal means kidney. The words “tumor” and “mass” mean abnormal growths in the body. A renal mass, or tumor, is an abnormal growth in the kidney. Some renal masses are benign and some are malignant .

    One in four renal masses are benign. Smaller masses are more likely to be benign. Larger masses are more likely to be cancerous. Some tumors can be slow to grow while some can be aggressive. Aggressive tumors form, grow and spread very quickly.

    Most diagnosed kidney growths are small and localized masses. Localized means that the tumor has not spread out from where it first started. Around 40% of kidney cancers are localized renal masses. Masses may be solid or cystic . Most cystic masses are benign.;

    What do we Know about Kidney Cancers?

    Kidney and renal pelvis cancers are the 11th leading cause of cancer death in the U.S. Kidney cancer is 8th on the list of the 10 most common types of cancer. Almost all of the kidney cancers in the U.S. are renal cell carcinomas . These cancers form in the lining of the small tubes in the kidney.

    Doctors are able to diagnose kidney cancer earlier because of better testing. Kidney cancer is more common in men than women. More men than women die from the disease. Kidney cancer is more common in African Americans, American Indians and Alaskan Native people. You can get kidney cancer at any age. But, it is more common in older people .

    Types of Renal Tumors

    Where are the Kidneys and What are they for?

    Staging For Kidney Cancer

    What Does Pain In The Kidney Area Mean?

    Clinical staging is performed with Physical Examination, Abdominal CT scan, and Chest X-Ray.; In cases of advanced or high-risk disease, additional testing such as MRI and Bone Scan may be necessary.

    The prognosis of kidney cancer is directly linked to the stage of disease.; Staging is a process that demonstrates how far the cancer has spread. ;Both the treatment and prognosis for kidney cancer depend significantly on the stage of disease.

    TNM System

    TNM SYSTEM
    Distant metastasis

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    Early Warning Signs Of Kidney Cancer

    Before symptoms of kidney cancer are noticeable, a laboratory test or an imaging study may reveal a possible diagnosis.

    For example, a routine urine test may find traces of blood that the naked eye cant see. Signs of kidney cancer also may be detected during a computed tomography scan, which consists of X-rays taken at different angles and processed by a computer into 3D images. This imaging test may show a growth in the kidneyand may even be able to tell a noncancerous cyst from a solid cancer tumor if dye is injected into a vein beforehand.

    Magnetic resonance imaging produces detailed images of the kidneys using a computer and magnetic fields in place of X-rays. During an MRI, a dye called gadolinium may be used to increase tumor visibility.

    Finally, an ultrasound uses sound waves to look for signs of a kidney tumor, and determine whether a mass in the kidney is a fluid-filled cyst or a solid tumor.

    What Is The Prognosis Of Angiomyolipoma Of Kidney

    • The prognosis of Angiomyolipoma of Kidney depends upon the severity of the signs and symptoms. It also depends upon the overall health of the individual, association with tuberous sclerosis, and response to therapy
    • Typically, individuals with small-sized tumors have a better prognosis than those with larger-sized tumors . Also, those with non-syndromic tumors have a comparatively better prognosis than individuals with tumors that are seen in association with a genetic disorder
    • In most cases, the prognosis of small-sized solitary tumors is excellent with surgical intervention or appropriate treatment, since these are benign tumors
    • Complications are seen in some cases leading to severely affected kidney function, even causing fatalities. This can occur from hemorrhage of tumor into the retroperitoneal space – mostly with tumors larger than 4 cm. Individuals with retroperitoneal hemorrhage may have a worse prognosis, if the condition is not treated immediately as a medical emergency
    • In pregnant women, such hemorrhage from AML tumors can be significantly serious affecting both the mother and child

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    Questions For Your Doctor

    You and your healthcare provider need to work together. Here are some questions to start the conversation.

    • Do I have kidney cancer?
    • Has my cancer spread beyond my kidneys?
    • Can my kidney cancer be cured?
    • What are my treatment options?
    • How long will treatment last?
    • Are there any risks or side effects associated with my treatment?
    • What will my recovery be like?
    • How long will it take for me to recover from treatment?
    • What are the chances of cancer coming back?
    • Should I also see a nephrologist ?
    • Will you be partnering with a nephrologist about my care?
    • Should I get a second opinion?
    • How much experience do you have treating this kind of cancer?
    • Are there any clinical trials I should think about?

    How Are Renal Cysts Diagnosed And Evaluated

    Advanced Kidney Cancer Life Expectancy

    Since they rarely cause symptoms, renal cysts are most often found during imaging tests performed for other reasons. In such cases without any symptoms, simple renal cysts are usually left alone and do not need any further tests. However, some renal cysts look more complex than the usual simple renal cyst. These complex renal cysts can have a thicker wall, or solid material inside instead of just fluid. Once complex renal cysts are discovered, additional imaging tests may be performed to monitor them and distinguish benign;cysts from cancer.

    Some types of imaging tests your doctor might order include:

    Abdominal Ultrasound and Pelvic Ultrasound: These exams are performed to take pictures of the kidneys and confirm the presence of fluid inside the renal cysts. Your doctor may use ultrasound imaging to monitor renal cysts for any changes over time.

    For more information about ultrasound performed on children, visit the Pediatric Abdominal Ultrasound;page.

    Abdominal and Pelvic CT: Often used as a complement to ultrasound in the study of complex renal cysts, this procedure can help distinguish benign cysts from tumors in the kidneys. A CT scan may include an injection of contrast material. See the Radiation Dose;page for more information about CT procedures.

    For more information about CT performed on children, visit the Pediatric CT;page.

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    What Are Causes Of Kidney Lesions

    Kidney lesions, also known as masses or tumors, can come from spreading cancerous cells. They also arise from fluid-filled growths called cysts. Most commonly, lesions consist of cysts, which are benign . Solid lesions turn out to be cancerous over 80 percent of the time, notes Urology Health Foundation. Doctors usually do not even biopsy solid lesions before removing them, because of the risk of false negatives and because of how rarely they are caused by anything else.

    Any anomalous growth inside the kidney is considered a lesion. Risk factors for having lesions that turn out to be cancerous include smoking, obesity, high blood pressure, a family history of kidney cancer, diet with fried meats or high caloric intake, chronic kidney failure or dialysis. Tuberous sclerosis and Von Hippel-Linday syndrome are two less-common causes, according to Urology Health Foundation.

    How Is Angiomyolipoma Of Kidney Diagnosed

    It is important to note that a majority of tumors are sporadic, while a minority of the cases is associated with a syndrome . The diagnosis of Angiomyolipoma of Kidney may involve the following tests and procedures:

    • Complete physical exam with evaluation of medical history: If angiomyolipoma is associated with tuberous sclerosis; then, the signs and symptoms of tuberous sclerosis may be noted. This can also help the healthcare provider to suspect the condition
    • Plain X-ray of the abdomen
    • CT or CAT scan with contrast of the abdomen usually shows a well-defined mass. This radiological procedure creates detailed 3-dimensional images of structures inside the body
    • MRI scans of the abdomen: Magnetic resonance imaging uses a magnetic field to create high-quality pictures of certain parts of the body, such as tissues, muscles, nerves, and bones. These high-quality pictures may reveal the presence of the tumor
    • Ultrasound scan of the abdomen
    • Urine analysis to check for the presence of blood cells
    • Kidney function test
    • Intravenous pyelogram : A dye is injected into the blood vessels and the image of kidney structure is obtained
    • Vascular angiographic studies of the tumor

    Note: CT, MRI scans of the affected kidney can usually help diagnose angiomyolipoma in the kidneys. An ultrasound imaging or CT scan studies can reveal the presence of the tumor due to its high-fat content pattern.

    Invasive diagnostic procedures such as:

    Tissue biopsy:

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