What Is A Lesion On The Kidney

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?

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.

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 â 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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Diagnosed With Kidney Cancer

We understand the anxiety that a diagnosis of kidney cancer can bring to the patient and their family. The most important thingone can do is to learn about this disease and enlist the help of an experienced team of physicians.

About 1/3 of kidney cancers are diagnosed after the disease has spread to other organs.

The first step is to obtain a “staging” evaluation to determine the extent of cancer. This typically entails obtaining imaging of the chest, abdomen, and pelvis and comprehensive blood work. Bone scans and evaluations of the brain are obtained depending on symptoms and the results of the initial studies.

PET scans are rarely obtained due to their lack of sensitivity for detecting kidney cancer.

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When To Get Medical Advice

See a GP if you have symptoms of kidney cancer.

Although it’s unlikely you have cancer, it’s important to get your symptoms checked out.

The GP will ask about your symptoms and may test a sample of your urine to see if it contains blood or an infection.

If necessary, they may refer you to a hospital specialist for further tests to find out what the problem is.

What Is An Angiomyolipoma

Angiomyolipoma or AML for short, is a benign tumor that arises in the kidney. AMLs can bleed and while not cancerous are still taken very seriously. “Angio” indicates blood vessels, “myo” indicates muscle, and “lipoma” indicates fat. Thus, an AML is a tumor that contains these 3 components. If one sees fat within the tumor on imaging, it is virtually diagnostic of this entity. Since they are benign, AMLs can be observed in some patients. If they are > 4cm in size they are usually treated. Treatment involves surgical resection or selective embolization. Embolization is a procedure where the blood vessels feeding the AML are blocked without surgery. This procedure shrinks the tumor and eliminates thus minimizing the risk of bleeding. “Who gets AMLS?” AMLs are most common in females between the ages of 40-60. Additionally, about 50% of patients with a syndrome called Tuberous Sclerosis will have AMLs. Tuberous Sclerosis is a genetic disease associated with seizures, mental retardation, and a skin condition called adenoma sebaceum.

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Staging For Kidney Cancer

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

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A Mass Or Lump Around Your Abdomen

A mass or lump in the abdomen, side, or back can also be a sign of kidney cancer. You might feel a hard thickening or bulging bump under your skin.

But kidney lumps are hard to feel, especially in the early stages. Thats because the kidneys sit deep in the abdomen. You may not even see or feel the lump as the tumor grows.

If you do discover a lump, a doctor or other HCP will likely order diagnostic tests, such as an ultrasound or a CT scan. These tests may help determine the cause of the lump. Youll typically need a biopsy to confirm the diagnosis.

Keep in mind that not all lumps are cancer. If youre concerned about a lump around your abdomen, a doctor or other HCP can offer guidance and information about next steps.

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What Is Kidney Cancer

Kidney cancer — also called renal cancer — is a disease in which kidney cells become malignant and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most kidney cancers are found before they spread to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected.

The kidneys are two bean-shaped organs, each about the size of a fist. They lie in your lower abdomen on each side of your spine. Their main job is to clean your blood, removing waste products and making urine.

Doctors don’t know the causes of kidney cancer. But certain factors appear to increase the risk of getting kidney cancer. For example, kidney cancer occurs most often in people older than age 40. These are some other risk factors for kidney cancer:

Having these risk factors does not mean you will get kidney cancer. And it’s also true that you can have none of them and still get the disease.

What Are The Symptoms Of Kidney Cancer

Kidney cancer, also known as renal cell carcinoma , is one of the 10 most common cancers in people. Doctors most commonly diagnose this cancer in people over 60 years old, often after finding it by accident during routine imaging tests.

The kidneys are two bean-shaped, fist-sized organs under the back of your rib cage. They help:

• filter waste from your blood
• create urine
• control blood pressure
• create red blood cells

Your body can function normally with only one kidney. But a tumor growing in one of your kidneys can disrupt its normal functions.

Most symptoms of kidney cancer have to do with kidney function and tumor growth, but these symptoms often dont appear in the early stages.

When symptoms do appear, they tend to show up in places like your urine or lower back.

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Causes Of Kidney Lesions

Their lesions are detected accidentally while doing investigation for other causes. While others may develop kidney lesion symptoms such as blood in the urine, back pain, pain in the renal region or impairment of renal function as it occurs in nephrosis.

There are number of causes for kidney lesion. Lesion is an injury to the organ tissue. Here the organ is kidney and the injury is on the tissue of the kidney either internally or externally. These lesions can be benign or malignant. Malignant lesions are cancerous while benign lesions are non cancerous, however benign lesions can make things worse if not taken care of in some cases.

• Glomerulonephritis can damage the kidney.
• Disease of renal vessels: renal infarction, renal vein thrombosis.
• Inflammation of kidneys called nephritis.
• Tumors: cancerous and non cancerous.
• Kidney stone.
• Uncontrolled hypertension.
• Multiple kidney lesions are common in malignancy.

All this conditions to a certain extent damage the kidney tissue and its function. In some the damage is reversible while in others the damage is permanent. Scarring of kidney can result due to inflammation of the kidney, infection, or it can also be due to surgery.

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.

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Rationale And Relevance For An Evidence Review

This review will provide a comprehensive review of current data that can help the AUA and other organizations prepare updated guidance on how to evaluate and treat patients with a renal mass suspicious for renal cell carcinoma. First, this review will synthesize current evidence on key issues in the evaluation of patients having a renal mass suspicious for renal cell carcinoma. Second, the review will synthesize evidence on the effectiveness and comparative effectiveness of different strategies for treating patients having a renal mass suspicious for renal cell carcinoma. The review also will highlight areas of controversy and identify needs for future research on the management of renal masses and localized renal cell carcinoma.

What Is The Difference Between Benign And Malignant Kidney Lesions

Malignant lesions are cancerous while benign lesions are non cancerous, however benign lesions can make things worse if not taken care of in some cases. Glomerulonephritis can damage the kidney. Disease of renal vessels: renal infarction, renal vein thrombosis. Inflammation of kidneys called nephritis.

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What You Need To Know

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

Localized Cystic Renal Disease

Localized cystic renal disease is a rare, nonhereditary, form of cystic renal disease, which manifests as a conglomeration of multiple simple cysts of variable size . In contrast to ACKD and ADPKD, localized cystic renal disease is typically unilateral and not progressive. The disease usually involves only a portion of the kidney with a polar predilection . Entire renal involvement is rare . The contralateral kidney is normal. The presence of interposed normal renal parenchyma and the absence of a capsule help to differentiate localized cystic renal disease from cystic nephroma and multiloculated cystic RCC . Cystic involvement of other organs is typically absent .

Fig. 13

Localized cystic renal disease. Axial contrast-enhanced CT image shows a conglomeration of multiple simple cysts of variable size in the right kidney

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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 Do We Know When A Tumor Is Cancer

Imaging tests help provide answers. At UP, we review different features of each imaging test to decide if a mass could be cancer. Depending on the original imaging test , additional tests may be recommended to get more information. Some of these tests may include an injection of an enhancera Gadolinium-based contrast agent to help show internal parts of the mass. Following testing, tumors may be referred to as an enhancing or non-enhancing lesion based on whether there was an uptake of the contrast agent in the lesion. Tests may be repeated over time to see if there are changes in the tumor. All kidney tumors are categorized as either cystic masses or solid masses.

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Understanding The T Word

The term tumor refers to an area in an organ that is not typically supposed to be there. A tumor may also be referred to as a mass, lesion, neoplasm or cyst. All of these terms mean the same thing, but none of them indicate whether or not a tumor is cancer. Often, tumors are found accidentally when an individual is undergoing x-rays for other reasons. Sometimes, they are found when investigating why a patient is experiencing side pain or blood in the urine.

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?

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