Kidney Biopsy Needed? Renal Cell Carcinoma

Posted by paulinlouisiana @paulinlouisiana, Jun 11 12:01pm

Just found out I have 4 cm renal mass concerning for renal cell carcinoma by CT scan. Local urologist says it is at the end of wait and observe period and the kidney needs to come out. 85+% chance it’s carcinoma. He gave me the choice to have biopsy or not on this coming Wednesday. I have my first appointment at MD Anderson 7-29-21. I feel like I will probably be using MD Anderson instead of local care.
My biggest concern/question: is there any possibility that putting a hole in the “mass” will release cells that might spread? Right now it looks like it is contained in the kidney. Any other cons of doing a biopsy?

@paulinlouisiana Welcome to Mayo Clinic Connect! I have had two kidney biopsies, and they can cause some complications. You must be feeling somewhat anxious at this point, understandably!

You did not say why you may turn to MD Anderson instead of local care. If you have established yourself with them already, and they know about the renal lesion, perhaps ask them their thoughts on the situation. I personally would ask the same question to the urologist, that you are asking us, phrasing it as, "If I was your relative, what would you advise?"

I look forward to hearing more from you and your decisions going forward. I myself also have a kidney lesion, on a "wait and observe period", and have 24% kidney function.
Ginger

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Hey Ginger. Thanks for your response. Just getting a message from you helps the anxiety a little.
I like MD Anderson’s history of care with people I know. The Mayo Clinic gets the best ratings but I’m not sure about the traveling back and forth. I have only had one appointment with the local urologist.
I researching today on the chances of the biopsy spreading cancer cells, but I’m not finding anything.
I like the way you phrased the question to the doctor. I plan on using that.
What did you think about your biopsies?

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@paulinlouisiana

Hey Ginger. Thanks for your response. Just getting a message from you helps the anxiety a little.
I like MD Anderson’s history of care with people I know. The Mayo Clinic gets the best ratings but I’m not sure about the traveling back and forth. I have only had one appointment with the local urologist.
I researching today on the chances of the biopsy spreading cancer cells, but I’m not finding anything.
I like the way you phrased the question to the doctor. I plan on using that.
What did you think about your biopsies?

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@paulinlouisiana Here is an older article that speaks about a techniques now commonly used for kidney biopsies
https://www.ucihealth.org/blog/2015/04/a-less-invasive-way-to-approach-kidney-tumors
My husband had a kidney transplant almost 5 years ago, and they used this guided biopsy technique with ultrasound, on the new kidney, for his biopsies. I was there in the procedure room room with him and was able to watch, pretty fascinating!

The term we are looking for is "seeding the tumor/lesion", and I would ask your dr on the possibility of that. From what I have found, most often if a lesion/tumor is of concern, they remove the kidney. Here is a paper from 2016 about tumor seeding, stating the chances are 1:10,000 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037124/#:~:text=Tumor%20seeding%20following%20biopsy%20of,current%20literature%20is%20shortly%20discussed.

My first kidney biopsy was Jan 2015, to determine my ultra-rare kidney disease, done on the right kidney. No complications, just no heavy lifting for 3 weeks. Second biopsy, done on left kidney, was Oct 2019. It caused some bleeding that required extra pressure on the biopsy site. I am grateful to the medical teams who performed them.
Ginger

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Thanks for the links. Both of them were very interesting. Your personal experiences are interesting too. I decided I need more clarity from my local doctor before a kidney is removed, so I scheduled another appointment to get more information. I feel like my first 20 minute appointment was very rushed. When I called back to cancel the biopsy, they wanted to know if I was ready to schedule the operation. I don’t even know how rushed I should be.

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@paulinlouisiana

Thanks for the links. Both of them were very interesting. Your personal experiences are interesting too. I decided I need more clarity from my local doctor before a kidney is removed, so I scheduled another appointment to get more information. I feel like my first 20 minute appointment was very rushed. When I called back to cancel the biopsy, they wanted to know if I was ready to schedule the operation. I don’t even know how rushed I should be.

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@paulinlouisiana, I agree that you should keep that appointment to talk to your doctor. If I might jump in here, are you planning to make a list of questions to ask? In my experience, it is easy to get tongue tied and nervous and forget what you wanted to know!

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Thanks Rosemary. Great idea. You are right. It is easy to forget something if you don’t write it down. I have a list I carry around with me. I add to it anytime I think of a question.

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@paulinlouisiana

Thanks Rosemary. Great idea. You are right. It is easy to forget something if you don’t write it down. I have a list I carry around with me. I add to it anytime I think of a question.

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@paulinlouisiana Two questions I have for you, are: How long have you been doing the "wait and watch" with this lesion? The activity of it may be telling to your team. Also, what is your eGFR? Yes, we can live with one kidney, if the remaining one is healthy. For example, in my case, I also am on a "wait and watch" with my lesion, but my eGFR is only 24%; a nephrectomy will put me onto dialysis.

Were you able to get an appt with your local dr to discuss things? If your town has opened up, you might consider taking a second person with you, to help listen to the details. As @rosemarya said, writing questions and notes down helps. For me, I sometimes have them repeat what they said because I was taking notes and missed something.
Ginger

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