Finding a kidney mass can be a surprise.
Treatment doesn't need to be.
Kidney masses are often found by accident.
If you're seeing Dr. Chertack for a kidney mass, here is some helpful information to answer many common questions.
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What is my kidney mass?
It is impossible to say what the mass is without removing it. Sometimes kidney masses can be cancer (malignant mass), but there are other types of masses that are not cancer (benign mass). The difference is that cancer can spread to other organs, but a benign mass will not.
The chances that the mass is cancer increases as the size increases - 60% (3 out of 5) are cancer when smaller than 1cm, compared to 80% (4 out of 5) around 4cm.
Where did the mass come from?
Often times kidney cancer happens randomly. Smoking can increase your chances for developing a kidney mass. Some genetic conditions can lead to kidney cancer, so if you have family members with a history of kidney cancer, your mass may be associated with this condition.
Why don't I have any symptoms?
Kidney cancer does not usually cause symptoms when it is small. Usually it is diagnosed at a small size because patients undergo imaging for another reason and the mass is found accidentally. Kidney cancer does not usually cause symptoms until it grows very large or spreads to other parts of the body.
Do we need to do anything else before treatment?
Dr. Chertack needs to confirm the location and size of the mass and look for any evidence of cancer outside the kidney. You will need to complete imaging of your chest and your belly. He will also need to check your kidney function with some lab tests. Rarely patients will need other special imaging or lab tests.
What are my treatment options?
First, it is important to know that chemotherapy or radiation treatment will not make the mass go away. Therefore all treatments require some form of surgery or procedural treatment.
Second, if your mass is smaller than 2cm (less than an inch!), it can be safely watched to see if it grows. Sometimes very small masses grow extremely slowly and can be watched for years with regular imaging. The available treatment options are ablation, partial nephrectomy, and radical nephrectomy.
What is an ablation?
This is a procedure where a specialized radiologist will insert a special needle through your back into the kidney mass. The mass is then heated or frozen to kill all the cells. You are able to go home the same day. This is a good option if the mass is smaller than 3cm and in a good location.
What is a nephrectomy?
This is a surgery to remove part of or all of your kidney to treat the mass. For more information, see the next section on this website.
What are the success rates for these treatments?
Research studies report the chances of being cancer-free after treatment are 95-98% for ablation and partial nephrectomy but it depends on the size and location of the mass. For very large masses that require removal of the whole kidney, the chances of cancer returning depend on different factors. After your treatment, Dr. Chertack will monitor for return of the cancer with labs and imaging over the coming years.
What about a biopsy?
This is an excellent question - in most cases a biopsy is not required. This is because when a biopsy shows cancer, it is almost always correct. However when a biopsy does not show cancer, this can be wrong up to â…“ of the time! Therefore a biopsy does not usually change the management decision or Dr. Chertack’s recommendations. However there are exceptions to this rule, Dr. Chertack will discuss with you whether a biopsy is recommended.
Why am I being sent for genetic testing?
If you are 45 years or younger or have a family history of certain types of cancer, Dr. Chertack will send you to speak with a genetic counselor to screen for different genetic conditions. This can be helpful for understanding your own health and the health of your family.
What if I have metastatic disease?
Unfortunately some patients do not get diagnosed with kidney cancer until it has spread outside the kidney (known as metastasis). At this point kidney cancer can be treated but usually not cured. If you are in this situation, Dr. Chertack will have you speak with an oncologist to discuss non-surgical treatment options. Surgery is occasionally needed but every patient is different, Dr. Chertack will discuss this with you if it is necessary.
Surgical removal of the kidney can be a straightforward way to treat kidney cancer.
What happens during my nephrectomy?
During this surgery, a portion of your kidney or your entire kidney will be removed, depending on the situation. Dr. Chertack usually performs this surgery with the DaVinci robot. This allows him to perform the surgery through 5-6 small incisions instead of one large incision. The surgery takes around 4 hours to complete. If Dr. Chertack is only removing a mass from your kidney, he will place a special packing to help compress the kidney and prevent bleeding after surgery.
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What are the different nephrectomy options?
Partial nephrectomy: Part of the kidney is removed, this is done for smaller masses that are easy to isolate while leaving the majority of the normal kidney behind.
Radical nephrectomy: This is done for larger masses that cannot be safely separated from the normal kidney tissue. This is usually done when the other kidney is normal and can support normal kidney function.
Simple nephrectomy: Some patients need a kidney removed for reasons other than cancer, whether for infection, stones, or because the kidney is not functioning well and causing pain.
What do I need to do before surgery?
You will need to complete the labs and imaging that Dr. Chertack orders.
Stop smoking - this is the best thing you can do to improve your recovery after surgery!
You will need to see your primary care doctor to confirm that you are as safe as possible to undergo surgery in order to decrease your risks.
If you take any blood thinner medications, Dr. Chertack will discuss stopping this prior to surgery.
You will need to take a laxative the night before surgery to empty your intestines, this helps make the surgery more straightforward. Eat normally until 6PM the night before surgery, then take the laxative and only have clear liquids after 6PM.
You will speak to someone from the ERAS group to help improve your recovery after surgery.
What should I expect after surgery?
You will stay in the hospital for one night after surgery, but almost all patients are able to go home the day after surgery. Make sure someone is able to drive you home and help you at home after surgery.
It is normal to be sore after surgery! You will be prescribed pain medications during your hospital stay, this will help get your pain to a manageable level.
After surgery, you will only be able to drink certain liquids. Usually the day after surgery these restrictions will be lifted and you can eat and drink whatever you want.
You will have a catheter to drain your urine after surgery, but this will be removed the first morning after surgery.
Sometimes you may have a small drain in your belly to monitor for bleeding but this is almost always removed before you leave the hospital.
You are able to walk immediately after surgery. Walking and moving around is the best thing you can do for your recovery! The more you walk, the easier and faster your recovery will be.
Often patients have some difficulty will bowel movements after surgery. You do not need to poop or fart before leaving the hospital. You will take stool softeners to help with pooping after surgery.
What should I expect when I leave the hospital?
You will be sent home with medications for pain. Narcotics are almost never required for pain control.
You will be sent home with stool softener medications, take every day until you are having regular bowel movements without straining.
There are no diet restrictions, you can eat whatever you want.
You should stay active to help with your recovery. However no lifting more than 15-20 pounds for 6 weeks after surgery to make sure your incisions heal.
Please let Dr. Chertack know in advance if you need any paperwork for your employer.
What are the risks of the surgery?
The risk of bleeding is low but not zero, occasionally patients do need a blood transfusion after this surgery.
The risk of infection is uncommon, usually you do not need antibiotics before or after this surgery.
Any surgery inside your belly has a risk of injuring your other organs, Dr. Chertack will be extremely careful to avoid any potential injuries!
If your surgery is for cancer, there is always a small chance of the cancer returning but this is usually less than 5% and you will be monitored with labs and imaging over the following months and years.
The majority of patients can live a normal life with one kidney, but you may be at higher risk for dialysis after having part or all of your kidney removed.
Is there anything I need to watch for after surgery?
Notify the clinic if you are having pain not controlled by medications, fever, severe nausea/vomiting.
Although rare, it is possible to develop a concerning kidney bleed 10-14 days after a partial nephrectomy. This causes sudden severe flank pain or sudden appearance of bloody urine. If this is the case, notify the clinic and come to the hospital urgently for evaluation!
When will I follow up?
Dr. Chertack will discuss the surgery results with you 2 weeks after surgery. Sometimes this can be done as a phone visit to save you a trip to the clinic. However please let Dr. Chertack know if you would prefer an in-person visit and this can be arranged.