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Our kidney cancer program focuses on each patient as a unique individual. We aim to choose the best therapy through an experienced team of surgeons, medical oncologists, pathologists, and radiologists.
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Diagnosed With Kidney Cancer
We understand the anxiety that a diagnosis of kidney cancer can bring to the patient and their family. The most important thing one can do is to learn about this disease and enlist the help of an experienced team of physicians.
Johns Hopkins Studies
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Johns Hopkins Kidney Cancer Program
TREATMENT OPTIONS - Active Surveillance
This is the least invasive treatment option. During active surveillance the patient and urologist agree to observe the tumor by obtaining regular imaging. For some patients, no intervention is ever needed while for others a "trigger for intervention" is reached and therapy is instituted.
Patients with tumors less than 3cm in size
In addition to a small tumor, several patient factors make this an attractive option:
What are the so-called "triggers for intervention"?
The most common trigger for intervention currently is demonstrated tumor growth. Change in the patient condition could also trigger intervention. For example, a patient who was having a heart attack when their 2.5cm kidney tumor was discovered has now recovered 1 year later and is fit for surgery. This now triggers an intervention.
What does active surveillance entail?
Typically we advocate imaging every 3-6 months for 2 years then every 6-12 months annually. The initial evaluation should include a complete staging evaluation (blood work, chest/abdomen/pelvis imaging) to exclude the possibility that the disease has already spread. We prefer CT or MRI for the initial evaluation and then alternate between CT, MRI, and Ultrasound to minimize radiation to the patient and to comprehensively evaluate the tumor. The exact protocol is customized to the patient.
Can the tumor spread while on active surveillance?
The answer to this is unfortunately YES. However, for a well-selected patient the risk of this occurring on surveillance is very low (<2%). Each patient and tumor are unique and this risk should be discussed with your urologist.
In patients who elect for delayed intervention, are the results compromised?
A recent study* by Johns Hopkins urologists showed that a period of active surveillance did not alter results. In this study, patients delayed treatment of their small kidney mass by over 1 year. All were eventually treated with minimally invasive surgery successfully.
*(Rais-Bahrami S, Guzzo TJ, Jarrett TW, Kavoussi LR, Allaf ME. Incidentally discovered renal masses: oncological and perioperative outcomes in patients with delayed surgical intervention. BJU Int. 2009 May;103(10):1355-8)
Does Johns Hopkins have an active surveillance program for kidney tumors?
How do I enroll in active surveillance at Johns Hopkins?
After a detailed evaluation by one of our experts, the patient signs a consent form and is enrolled in our formal prospective registry for active surveillance. We will follow the patient with regular questionnaires evaluating his/her quality of life and review all imaging at regular intervals to optimize their. Each patient has a personalized schedule. For example a 90 year old patient with a 1cm tumor may want to be imaged once every year. In contrast a 45 year old patient with a 2.8cm tumor will likely be imaged at more frequent intervals.