Kidney Cancer

[rmc22]

I am a 44 year old male, who has recently had a 2cm x 1.9cm mass found in the mid/upper pole of my left kidney by ultrasound.

I’ve been having low-level intermittent abdominal pain, in an arc around my front right side about two inches below my rib cage, for about a year. The Doctor suggested blood tests (found nothing) and ultrasound. The ultrasound operator declared she’d found nothing, but the report faxed a few days later by the hospital raised an unidentified 2cm x 1.9cm mass (maybe 'irregular area' was the phrase used?) as an urgent concern, indicating immediate Urology referral and MRI scan. It’s unclear whether the left kidney mass is related to the right abdominal pain, or was just an accidental discovery.

It’ll be almost two weeks before I see the Urologist a difficult time in which I’m trying to remain positive and not jump to the worst conclusions. This is not easy. My Urology appointment letter contained a leaflet about cystoscopy examination, I was surprised by this as I’d assumed the kidney would be the immediate focus of attention, not the secondary bladder aspect. I had a cystoscopy 10 years ago (under general anaesthetic) as part of a prostatis/testicular pain investigation, leading to a diagnosis of non-bacterial prostatitis (no other physical problems found), although I haven’t been troubled by these conditions as much since then.

Allowing for another cystoscopy for the sake of thoroughness, I’d like to know what treatments you think I should expect to diagnose the 2cm kidney mass? Is an MRI scan (not always readily given in the UK, for cost reasons) to be expected as a ‘minimum’ diagnostic requirement? Is it likely that a left kidney problem is the cause of right abdomen pain? Is it credible that the mass could be a cyst, or stone related, or other less serious condition? Is a biopsy likely to be required?

Any thoughts or opinions gratefully received. I have posted this question in the 'Kidney Cancer' section as the closest match, but I am not making that assumption yet. But I'd appreciate realistic replies, if you think this is bad, please say so.

[gborin]

Two days before my Kidney Cancer surgery and about 1 month after my diagnosis my Urological Oncologist who did the Surgery made me have a Cystoscopy in his office to rule out Bladder Cancer.

I can not understand why it takes you 2 weeks to see a Urologist. I assume that the Urologist will order a CT scan which is much more definitive as to whether this is Kidney Cancer.

Good luck. Mine was 7 years ago and as I look back it was just an unpleasant bump in the road on the way thru life. Well a little more than unpleasant.

[rmc22]

Thanks for the reply. I can understand the cystoscopy I suppose, given the risk that a cancer could have washed down into the bladder.

The plus side of the UK is 'free' medical treatment, however the downside is 'rationing' of treatments (MRI is hard to obtain unless already clearly indicated, losing it's value as an early warning system) and long waits. The two week delay for hospital referral is a brand new government target, just met to the day in my case. Previously, people waited much, much longer. It rather puts your life on hold for the wait, however.

Meanwhile, anyone who knows if this can or cannot have non-cancerous origins, I'd be happy to hear from.

[rmc22]

I've just enquired with the clinic which I will be soon seen in, and thus far, cystoscopy is what I'm going in for, followed by seeing the consultant.

Can someone please reassure me that I am not wrong on the following point: If all I get for this visit is cystoscopy, and no futher imaging (Xray/CT/MRI) takes place at this time after a two week wait, I will not have received appropriate treatment?

I have no 'bladder symtoms' at all, just the 2cm kidney mass to identify. Unless some kind of specilaist dye insertion plus Xray takes place, surely the cystoscopy can see no futher than the point where the ureters enter the bladder?

[s2usy]

I am a 44 year old female, and like yourself, have just been diagnosed as having a 2.5cm massin my left kidney. I had originally gone to the gp suffering from pain just underneath my sternum (like a severe heartburn) but was also suffering extreme tiredness and weakness. Taking symptoms into account, my gp referred me for blood tests, which came back with slightly abnormal liver function and slightly abnormal ESR results. As the pain was in my upper abdomen, my gp sent me for an ultrasond of the gallbladder and liver. Suffice to say, all came back clear on the gallbladder and liver, and lo and behold, an unknown mass was seen within the kidney (talk about go in with one thing and come out with another!!!:()
I was then referred to a urologist, whom I saw two weeks ago. He said the mass had a "fatty" look to it, something like the heamanginomas I was diagnosed with on my liver 9 years ago (benign kind of birth marks!) However to be on the safe side, he referred me for a CT scan, which I had yesterday afternoon at the Royal LIverpool Hospital.
So like you, I am now waiting on the results (which I get next Wednesday afternoon) and am slightly concerned to say the least. Another strange thing is that just this morning I have had a strange sensation when having a wee, rather like I am unable to properly empty my bladder and at the end of the week, there is pain, rather like something pushing down and about to drop out of me! No sooner have I stood up , I feel the need to go again!! Over the course of the day, this has cleared up somewhat, but I had a similar experience two years ago, which culminated in a horrific pain and a blood loss and I was immediately sent for ultrasounds on my kidney at that point, which incidentally came back totally clear, and the pain and blood loss cleared up after a few days....with no reoccurence since (until just today!)
So I am totally confused, concerned and worried. I have also had lower back pain (accross the muscles at the bottom of my back, not around the kidneys or side) for a long time now, and am wondering if this is all linked.....
Is there any chance I could have poly...cysts or whatever they are called? Do cysts bleed, and can they cause pain? Or can benign "fatty" lesions cause pain when urinating or is thi simply an infection which is just by chace come along at the same time as these investigations....
I had not even thought of a kidney cancer affecting the bladder and am now more worried than ever! I am otherwise healthy, fit, happy and in good health, with no weight loss and no pain in my stomach or sides....

[rmc22]

s2usy,

Thanks for the interesting reply! Just as I was starting to conclude this was another 'dead' medical forum...

I think that there are both similarities and differences to our symtoms, for one thing you are much futher down the diagnostic route than me, and also seem to have some prior significant medical history, whereas this is the first time anyone's mentioned kidneys to me.

I am obviously not a doctor (well, I suppose no-one is in a peer-to-peer forum) but I have to say that your comments re pain passing urine sound rather like a Urinary Tract Infection. I suppose that if something was wrong with your kidneys, the products might wash down into your bladder and cause irritation there, but equally you could just have an unrelated urinary tract infection. Urine analysis could shed some light, one GP I once visited had 'dip test papers' in his surgery and could confirm some basic urine problems there and then. I'm not sure if your saying you now (or just once) had blood in urine, but this seems to a symptom which must always be followed up properly.

As an aside on pain urinating, I can sympaphise as someone who has known prostatitis before now (which I guess is one condition you can cross of the list!). On the subject, I recently stumpled upon a condition called 'Interstitial Cystitis' (http://en.wikipedia.org/wiki/Interstitial_cystitis/painful_bladder_syndrome), which rang some bells to me. That, and a book 'A Headache In The Pelvis' (see Amazon) are worth a look. To cut a long story short, stress etc can affect your pelvic muscles and cause related bladder/urogenital symptoms. I'm not for a moment saying your symptoms are solely stress caused, but think any sufferer 'down below' should be aware that how you feel in your head can exacerbate pelvic pain, and waiting a long time for potentially serious medical results, certainly does little to calm your nerves.

I'm afraid I don't know enough about the fatty lesion aspect of your problems. From what I've found so far, kidney cysts are just water filled areas which are usually not considered serious. Up to half the population have them by 50 (so we're both in an age group when they'd be common), mostly they cause little or no symptoms and often they're not even operated on. If they cause pain e.g. by swelling the kidney and pressing on other organs) then they may warrant surgery, it would seem. I'm 'hoping' (if that's not too ironic) that they're what I've got, but realise that other less minor possibilities are still on the table.

The pain under your sternum sounds similar to mine, which was relatively minor and something I almost ignored for a year. I think that pain in the back can be due to kidneys acually, but then lower back pain is so very common that it's hardly a conclusive symptom.

You must post when you've got your MRI results (was it a struggle to get a scan, I've found Doctors very unwilling to do these so far?). By this time tomorrow, I'll have had my cytoscopy and should have seen a consultant. I am not looking forward to the general pain/nastiness of the procedure, and am still less comfortable at the inference that there is 'something to see' in my bladder. Until someone has suggested anything really bad is going on in my kidney, I feel like my bladder should be left alone, if that doesn't sound too stupid?! I'm hoping this is 'just procedure', with me getting peripheral tests before I've even had the main thing diagnosed, but it's easy to read too much into these things when (as you know) UK treatment is slow and often poorly explained to patients.

I'll try and post again tomorrow with as much (or little) as they'll tell me.

[s2usy]

RMC22,

Good luck tomorrow...we can do nothing more until results are known, and hopefully our fears and concerns will be for nothing.

Incidentally, the pain I was having on urinating has completely disappeared today...strange....but I have drank plenty of water. I had a dye injected into me on Monday for my CT scan which I was advised would make me dehydrated - maybe that was one of the reasons for the pain?? who knows..probably not.

I am thinking that neither of us has kidney cancer, and the probability is that it is a cyst or benign lesion. I have two of these on my liver, which were picked up nine years ago when I had abnormal liver function tests and had an ultrasound then. The consultant advised me that these are completely harmless, and are quite common. The Urologist consultant advised that the thing on my kidney has a very similar appearance. So my fingers are crossed.

Thanks for your supportive and positive comments...I am off on holiday next week for five weeks, and am determined I will be going, come what may. After all, I feel and look completely healthy and fit, and after the stress of recent weeks, am well in need of the break!! Keep posting on your results, symptoms etc. It helps to share the worry!!.

[s2usy]

Saw gp yesterday for results of ct scan. Both the Urologist and the radiologist are both of the conclusion on further examination, that this is a benign tumour, but for safety have now referred me for an MRI scan. All blood tests have returned normal. In particular, all blood tests relating to kidney function are completely as they should be, and everything is in good working order, so they are happy for me to have my extended holiday and have mri on return!
Found out that I also have an irregular shaped right kidney with scarring and two ureters, a bulky uterus and a possible fibroid! Talk about go in with one thing and come out with another....?:)
Will post after mri resuts are known.

[rmc22]

s2usy,

I'm pleased to hear that your lump is probably benign, I know that anything is better than some awful cancer, and having read lots recently, I know that not all things which show up in a kidney are necessarily dreadful. Reading some of the sad posts in this forum, I think this is a pretty good outcome. Fibroids themselves can cause plenty of problems, and perhaps muddy the dianostic waters of any other problems in that region. I know someone who had her ureters damaged in a fall whist fairly young, and underwent regular scans (some kind of X-ray, possibly CT) to monitor them until she had grown up more, the body having better ability to recover whilst still growing it appears.

My own case turned out brilliantly. I was admitted for the routine urine/blood tests and ultrasound, and was literally in a gown and on a trolly, about to be wheeled into theatre for cystoscopy, when I managed to get a word with the consultant. A lovely man, it soon transpired I was in a 'haematuria' (blood in urine) clinic despite not having had such a symtom in a decade. A quick symtom check confirmed I was in the wrong place, that they were very unsure what (if anything) the strange looking ultrasound mass actually was, and so a CT scan was arranged instead. The very helpful hospital staff got me in quickly, this being the helical CT type with iodine injection which seems highly regarded.

The staff rushed the results through, confirming nothing whatsoever wrong with either kidney! The mass appears to have been some kind of unclear image on the ultrasound, which then kicked off the 'cancer fire alarm' and thence the whole panic/liabilty passing system via local doctor's surgery etc. I cannot praise the NHS hospital staff highly enough, whilst the surgery who rang me 5 times in one 2 hr period, deserve shooting for their lack of proportionate response. Im my opinion, their 'duty of care' (a pleasant phrase to hear from your Doctor) includes not panicking patients, and not just passing on worrying results in a manner which exaggerates their sigificance.

I still don't know what my right flank pain is, but am starting to feel less worried about this after reading so many sad stories here. I feel almost guilty posting such a good result in such a serious forum, but I suppose at least this thread will stand for future readers who struggle to maintain a balanced and positive state of mind 'when all about you are losing theirs'.

Please post when you have more results, I hope it's a simlarly good end for you too.

[s2usy]

rmc22

Delighted to hear your good news!! It is good, as you say - after reading some of the much less fortunate posts - to be able to feedback some good news. And it just shows, that not all "shadows/things/masses etc" are cancer...
My sympathy and thoughts go out to all of those on hear whose diagnosis is not as fortunate as yours (and hopefully my own) - and lets hope that this topic will offer some hope to others starting off down that first frightening path...
I will post with my (hopefully!) final results in September. But firstly I am off to Turkey for a well deserved 5 week break!