DEAR DR. ROACH: I am 62 years of age and in excellent health. I run or hike 3 miles or more on most days, and road bike, swim and weight train. I eat sensibly, and I don’t drink, smoke or take drugs. I don’t drink coffee or even take aspirin for pain. My last physical exam showed no problems, and my blood and urine tests were fine.
Recently, I was diagnosed with a small tumor inside my right kidney. It’s about a 2.5 cm solid mass with no rough edges at this time. The MRI showed “a 2.4 cm mildly enhancing solid mass concerning for a renal neoplasm.” It also showed that the left kidney has a single 1.2 cm cortical cyst over its upper pole aspect. Please explain what this means.
The options for treatment are to completely remove the kidney and see if it is cancerous or just monitor the tumor and see if it continues to grow and remove later. The doctor said the whole kidney has to be removed, because of the central location of the tumor. The doctor also said a biopsy is not a good idea where the mass is located for fear of releasing cancerous cells within the kidney that could move quickly throughout the body. Removal is a drastic measure, no doubt, to test for kidney cancer. Should I just monitor and wait to see what the tumor does or operate and have the kidney removed. What medical action do you suggest that I do? — B.J.R.
ANSWER: I am sorry to hear about your kidney tumor. A solitary kidney mass in a man in his 60s is always suspicious for kidney cancer. A 2.4 cm tumor is large enough to provoke serious concern: In a recent study, in people who had their tumors removed, 83 percent of tumors that size were kidney cancer.
Because of the location, a partial removal of just the mass is impossible, so the choice between watching and waiting versus taking the whole tumor out should take into consideration the very high likelihood that this is cancer. Kidney cancer can spread to other organs. If you were my patient, I likely would advise surgery. If you were not a good risk for surgery (say, in your 80s with multiple medical problems), then I might consider watchful waiting. In your case, I think going for surgery is the wiser course. Being so healthy will make your treatment much less risky.
DEAR DR. ROACH: Does BPH increase the possibility of prostate cancer? — A.L.
ANSWER: Benign prostatic hypertrophy is a common condition in men. About half of men in their 50s have an enlarged prostate, and the proportion gets even higher as men age. The major symptoms of enlarged prostate are difficulty with urine flow, a sensation of decreased emptying, difficulty initiating urination, and increased frequency of urinating, including at night. As symptoms worsen, incontinence can occur and even kidney damage may result due to the high pressure in the bladder.
The first word in “BPH” is “benign”: It is not a cancerous condition. It does not protect against developing cancer, but there does not appear to be an increased risk for cancer among men with symptoms of BPH, according to the most recent studies.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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