Emergency Physician Questions Emergency Care

Kidney Tumor

My father is 85 years old. In 2015, a scan revealed that he had a 2.5cm cyst on his right kidney. Since then, he had yearly scans done to monitor the growth. Thankfully, it did not grow. However, during the pandemic (2 years), he did not have any scans done. Two months ago, he had an ultrasound done and it revealed a 9cm mass on his right kidney. A month later, he had a CT scan done, and it had grown to 11cm. The tumor is contained, it has not spread to any other organs. He does not have any symptoms, but a blood test revealed hematuria (microscopic). The oncologist told us that he is 90% certain that the tumor is malignant. We are confused. How could he have a cyst/tumor on his kidney for more than seven years, and it has not spread to other organs, with it being so large. We asked the doctor if there is a chance it could be benign (oncocytoma). But he is not too confident that it is.

Male | 85 years old

4 Answers

Have they suggested a biopsy of the mass ?
There are two types of genes that can cause tumors, proto-oncogenes or tumor-suppressor genes. Tumors occur when a gene sequence gets inappropriately turned on or off respectively, thereby causing uncontrolled growth. This can occur by a number of mechanisms: damage from environmental factors such as radiation or chemicals, an error in the replication of DNA when the cell divides, even changes in diet or physical conditioning (obesity has been linked directly to several cancers). While a tumor may start as benign (little to no chance of metastasis or invasive growth), additional changes to DNA may turn off genes that were keeping it controlled or turn on genes that promote uncontrolled growth. There are some protective factors, but many of these changes are cumulative and increase over time. The older we get, the higher the chance that the right combination of errors occur.
It doesnt spread because renal cell carcinoma is unique like that. Even at gigantic sizes, they are still curable. It is one of the few cancers that are like that. This answer is for educational purposes only and does not constitute individual medical advice. I strongly advise everyone to consult with their regular physician before embarking on any treatment plan, and this is not intended to be a substitute for any form of in-person medical care.
Dear Patient,
Unfortunately, your oncologist is probably right. Tumors can start out as benign and undergo a malignant transformation. It is important that he get a biopsy as soon as possible and the appropriate care.
Hoping for the best outcome.
David Akinpelu, MD