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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3561
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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Im a 58 yr old female, good health. Recent CT scan shows

Resolved Question:

I'm a 58 yr old female, good health. Recent CT scan shows mid-pole, 1.6x1.2x1.1cm complex cyst (some calcifications and septations); hounsfield units of 22; and hypodense relative to renal cortex.

I see the urologist on Wednesday to discuss options to a) check again in 6 months; b) biopsy; or c) excise.

What questions should I be asking to make sure I have the information needed to make an informed decision?
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Tharun replied 1 year ago.
Hi

Do you have blood in urine ?

Are you hypertensive ?

Do you smoke?

Are you overweight ?

Any symptoms you have like pain, discomfort etc?

Family history of cancers ?

Why was the ct scan done ?

Please let me know

Dr.Tharun
Customer: replied 1 year ago.
No blood; slim; low to normal blood pressure; don't smoke; no history of family cancer. Approx. 3 weeks ago I went to doctor to see if upper abdominal pain was gallbladder - was sent for sonogram the following week. Identified complex cyst and rescheduled for CT on 5/14/13.
Expert:  Dr. Tharun replied 1 year ago.
HI

A complex cyst with calcifications and septations can be classified into bosniak classification II or II F.It depends on what the radiologist classified it as.Single septa and calcification is usually classified as type II.
Type I and II need not require any intervention.Type II F requires observation with regular scans to see whether the lesion is progressing or not.Type III and IV requires surgery for sure.
Some calcifications and septa can either come in II or II F.So the treatment would either be wait and watch /leave it alone or observation.It depends on the CT report.

The size of the lesion is small and hence chances of it being cancerous is really less.But there could be exceptions.Biopsy has very less role in renal lesions
It can be done when the doctor strongly feels the lesion to be a benign one and wants to avoid unnecessary surgery on it.

Also you don't seem to have any high risk factors to develop renal cancer.That also goes in favor of you.

I hope this gives you the necessary info regarding the problem you have so that you can have a proper discussion with your urologist about the treatment.

Regards

Dr.Tharun
Customer: replied 1 year ago.
I appreciate the information that you provided, however I was already aware of these facts (I have spent the last 2 weeks reading journal articles, papers, and clinical study data). What I was looking for was the best QUESTIONS to ask the urologist when we meet next week.
Expert:  Dr. Tharun replied 1 year ago.
HI

The main question here is whether the cyst is cancerous or not.If it is not cancerous there is nothing to be done by the urologist than regular follow up.Whether the lesion is cancerous or not depends up on the CT features.In kidney masses the imaging is the deciding factor to go ahead with the surgery or not.As I mentioned earlier renal biopsy has little role in diagnosis of kidney cancer.


What urologist would look is whether mass looks to be cancerous or benign on CT.It is better to err on the side of cancer in suspicious cases.So if in doubt go for excision of the tumor.Only 20 % of tumors which are less than 3 cm are cancerous.Rest are benign or very indolent which can be observed.

Again mid pole tumors are difficult to remove alone as it is closer to the blood vessels supplying the kidney and also the PC system(where the urine is formed). So injury to these structures precludes a partial removal of tumor alone.But still it can be done.

The questions arise if the lesion is cancerous.Then a number of questions come like what is the stage of the cancer and has it spread to the lymph nodes or not.Whether there is spread to other parts of the body.
If the mass is operable,then can a partial nephrectomy can be done or not.What are the chances of the cancer coming back if it is removed by partial nephrectomy.Whether the surgery would be done laparoscopically or by open method.What are the chances of complications.

In summary it would be better if these questions never arise in your scenario.

All the best.

If you have any specific question to ask which you think I missed , please don't hesitate to point it out.

Regards

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3561
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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