Curious about follow-up cancer tests

Dear Dr. Roach: In 2010, my husband had an abdominal/pelvic CT scan (for an unrelated reason), and they found a 14-mm mass in his lower right kidney. In 2017, a repeat scan showed the mass was much larger, and he had the kidney removed. The pathology showed a 48-by-40-mm papillary kidney cancer, type 1. We were told that removing the kidney would be curative, and no other testing (scans) have been ordered. We have not been told of specific type or staging. I had breast cancer in the past (mastectomy and radiation) so am familiar with the process. Is renal cancer different? We just feel out of the loop and that we should have more information on this cancer. He has lost a lot of weight. — K.K.

Answer: Several kinds of cancers start in the kidney, but papillary kidney cell cancer is a less common type. Fortunately for you and your husband, type 1 cancers generally are not as aggressive, and people with this kind of kidney cancer have a better prognosis than people with other types. It is completely obvious, at least in hindsight, that the 14-mm mass should not have gone so long without a follow-up.

Around the time of diagnosis, an evaluation is undertaken to look for evidence of spread, including a CT scan of the lungs. Kidney cancer also can go to the bone, so if he had any bone pain or elevated blood tests showing bone damage (called alkaline phosphatase), most experts would recommend a bone scan as well. If there is no spread, the five-year survival in people with this type of cancer is greater than 90 percent. No chemotherapy is indicated if there is no evidence of spread. I would recommend a visit with a medical oncologist, just to make sure his workup is complete.

The weight loss is concerning. It may indeed have been the tumor; cancers can make substances that cause people to lose weight. However, I personally wouldn’t stop looking, especially if the weight loss continues.

Dr. Roach writes: A recent column on multiple myeloma noted myeloma is uncommon in younger people. About 3.5 percent of myeloma cases occur in people under 45; however, that is still a lot of cases, and many physicians are unaware that this cancer can occur in young people. You can learn more about this cancer at myeloma.org.

Readers: The booklet on restless leg syndrome and nighttime cramps offers more tips. Readers can obtain a copy by writing: Dr. Roach, Book No. 306, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient’s printed name and address. Please allow four weeks for delivery.

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