Watching Instead Of Cutting Out Cancer

Kidney cancer tumors of 4 cm or less can be actively watched

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) As imaging technology advances, smaller cancers can be detected. What we’re learning – as in the case of prostate cancer – is that surgery doesn’t always have to be the first treatment option.

Avoiding surgery with active surveillance is a safe approach for kidney cancer masses 4 cm (about 1.5 in.) and smaller.  

Those who didn't have surgery lived about as long as those who did in a recent study.

"Ask if surgery is required."

Researchers from the Department of Urology at Churchill Hospital in Oxford England conducted the study.

Lead study author, Dr. Nilay Patel, says kidney cancer has been on the rise both in the U.S. and Europe since the 1980s. He goes on to note that “sophisticated imaging techniques means smaller masses of less than 4cm are being picked up at earlier stages."

"This has led to an increased rate of surgery for small kidney masses, but the benefits of this remain unclear. Conflicting reports on improvements in death rates for kidney cancer over the last few years suggest that increased detection may not necessarily be improving survival rates for patients with smaller tumors inside their kidney," Dr. Patel said.

Active surveillance – where the disease is carefully monitored for progression - is currently used with elderly patients at Churchill Hospital and those who are unable or unwilling to undergo surgery. The researchers wanted to learn if it would be appropriate for younger folks.

For this study, researchers worked with 202 patients who had 234 small renal (kidney) masses.

The individuals received one of three treatments: a partial nephrectomy, in which the disease part of the kidney is removed; a radical nephrectomy where the whole organ is removed; or active monitoring.

Researchers learned that the people who were watched lived about as long as those who received surgery.

The overall survival rate was 83 percent for the active surveillance group, 80 percent for those who had partial kidney removal and 90 percent for those who had removal of the entire kidney.

The cancer specific survival rate (a measure of who died because of the cancer) was even better for those who were observed, 99 percent, vs. 93 percent for radical and 97 percent for partial nephrectomy groups.

"Our research suggests that active surveillance of small kidney masses offers similar cancer outcomes to radical or partial surgery in the short and intermediate term" said Dr. Patel, who added that randomized trials are necessary to confirm these findings.

Kidney surgery, depending on what is removed and length of hospital stay can range from about $3,500 to $12,000. Active surveillance costs nothing more than doctor visits and lab/testing fees.

This study was published in the November issue of the urology journal BJUI.

Reviewed by: 
Review Date: 
October 18, 2012
Last Updated:
October 19, 2012