Hearsay is not news, Freddy. I am a cancer survivor (melanoma) and nephrologist (kidney physician) but not a urologist (kidney surgeon). The paper quoted in this article provides important information that is helpful for physicians and patients to make care decisions. As an observational study, however, it should not be over-analyzed.

The gut reaction to a diagnosis of cancer is always "get it out!" This paper tells us that this might not be the correct choice for all patients, and that the loss of a kidney is not a trivial thing. This is something most nephrologists knew all along, and it is nice to finally have a supporting study.

However, if I ever receive a diagnosis of kidney cancer, I'm going to follow the advice of my Urologist regarding surgery and would not refer to the lay press for guidance.

Heinrich, since you're a nephrologist maybe you can help me here - I have PKD, with a GFR of approximately 25, and my husband (a very healthy 56-year-old) has offered me one of his kidneys when the time comes. Has any study shown that kidney donors have a shortened life expectancy because they're minus a kidney? This study seems to suggest that, and if so I don't want to put my husband's future at risk for my sake.

This type of study, while interesting, is far from proving any correlation. The problem is that this addresses all people who had tumors and does not discuss the size of the tumors involved. Since those with smaller, slower growing tumors were more likely to go for watching and waiting, the study becomes automatically biased. Those with larger tumors are of course more likely to have surgery and are also more likely to have other complications. Also, the larger the tumor that is being removed, the greater the chance of complications from the surgery itself. I think that the idea of watching and waiting for certain types of cancer, particularly in older people is definitely an idea whose time has come and it deserves more study that looks at all the variables involved in the decision. I have no doubt that for many older people the risks involved with the surgery may outweigh the benefits. This would be particularly true for those with small, slow growth tumors where they are far more likely to die from other causes long before the cancer ever begins to affect them.

JS- The tumor size considered in this study was less than 1.5 inches (~0.5 cm3), its in one of the middle paragraphs.

@ckneely,

JSinSD posts similar posts on everything from Sandusky's presumed innocesence to the Mars rover's procedures. He always disagrees with everything in the article. In this case he starts off with a complete fabrication --- that the study does not show a correlation. In fact, the study does show an extremely strong correlation, but not a causation (which would require experimental elements.) The article clearly states the difference right up front.

@HeinrichKroll,

Extremely good post! Bravo! Good luck with that Pfalz. LOL

What if they do a follow up for 6, 7 or 8 years? Will the odds change? Are they inferring that surgery causes heart problems, or that patients with heart problems don't fare well after surgery?

This study has so many confounding variables, plus it's short sighted. I mean a 66 year old does not want to die of kidney cancer at age 75, while an 80 year old probably won't make it to age 90 anyway.

I should qualify by saying "patients with a family history of heart problems" since they developed the heart problems afterwards.

This has always been my beef with our medical system.

Why dont we monitor and follow EVERYONE who gets sick with a disease, whether or not they choose treatment...until the day they die?

Im not talking about heavy investment in doctors, im talking about a simple way of monitoring - such a reporting system.

My wife has MS and has had it for over 10 years, she's only 32.

We have not seen a neurologist in over 4 years because the last one told her "if you dont want to take medication, there's nothing I can do for you and therefore no reason to see you"

we've basically had the same thing from other neurologists, though they did not outright say "dont bother to come back".

Im sure, in other area's of the country it might not be the same...but thats not the point.

There should be SOMETHING or SOMEWAY for anyone with a disease to be able to report their progress (along with their doctors to report the progress as they see it) into a massive database.

That way, we have a much clearer picture of what is happening and why.

I suspect the reason we dont do this is because we'll probably find just how ineffective most of our treatments truly are...and FLUSH would go all the money.

First do no Harm

... unless there's a pill, a procedure, or a screening for it. Especially if you can get an endless stream of office visits out of it. Like that cholesterol BS. Doing no harm doesn't pay as much

Why?

Because the post-surgical pathology showed that he had two different types of cancer in that kidney - neither of which was really showing on an MRI or other tests. One was slow growing as this article discusses, and one wasn't. I would like to know what constitutes "having symptoms"... My husband was passing blood for a year before this diagnosis was made...

I don't know who the author of this article is, but this issue is not as simple as she writes. My suggestion here is trust your doctor, or find a doctor you can trust, and take his/her advice. Do not rely on a "study" or an AP reporter to make a healthy decision. I don't think articles like this should be written by non-medical people.

This is reducing costs for Affordable Care Act. Cheaper to let people die. A friend ignored a tumor, waited too long and it spread to all of his organs; he recently passed away. So does waiting allow it to spread to the other organs? Then the question becomes "Why bother if it has spread to the other organs?"

The reason scientific studies are done is that doctors are prone to cultural biases, cognitive errors, and irrational fears just like the rest of us (plus, they have financial motivations and a sometimes obsessive fear of litigation), so not all practices that American medicine promotes are the best choice for every patient they're recommended to, or occasionally for anyone at all. And there are many subjects on which individual doctors disagree greatly. Trust a single doctor's opinion over published scientific literature? I don't think so. On the contrary, if my doctor's opinion strongly contradicted the best available science, I'd conclude that either she does not keep up with new research or her cognitive biases do not permit her to absorb any information that she doesn't already agree with. Either way, she wouldn't qualify to be the ultimate arbiter of which of my vital organs I get to keep.

This article makes a good point. We now know that there are certain cancers, like prostate cancer, where the patient may do well with just monitoring. With medicare cuts looming as part of Obama's Affordable Care Act, we may see more of this in order to save money. This is not necessarily bad, and most physicians would be willing to follow appropriate watch and wait protocols except for the fear that one day they may be in court with a plaintiff's attorney pointing their finger at them while saying: "You knew my client's loved one had cancer and yet you did NOTHING!.

This is reducing costs for Affordable Care Act. Cheaper to let people die.

Hey, it has nothing to do with the ACA. The health insurance companies have been doing it for years.

Try getting pre-approval for an "experimental" procedure that's been in common use for 5 years. They'll try to stall you until you die.

Bone marrow transplant for breast cancer might have been said to be "in common use" for five years, and then when it was rigorously studied it turned out that all it did was torture 10 or 20 percent of its victims to death while sucking the money out of their estates. Granted that insurance companies refuse to pay for legitimate treatments whenever they can get away with it, but when they try to refuse to pay for heroic experimental treatments they may actually be doing you a big favor.

I'm not talking about actual experimental procedures. I had a friend who was denied a bone marrow transplant for leukemia because a bean-counter at her insurance company made the arbitrary decision that it could still be considered experimental.

It took multiple calls and letters from cancer treatment specialists at several hospitals over a 3 month period before they finally agreed to cover it. Fortunately she managed to get the transplant, and today is alive and well; the disease in remission.

If her insurance company had stalled for another six weeks the outcome would have likely been different.

Jane... not sure where you are getting your information - have you conducted any studies? Note - I didn't say participate, I said conducted. We are talking about kidney cancer here, not breast cancer - two very different diseases.

Before you trust the scientists with your life, you should "study" the studies. They really are not all that... I would NEVER trust my well being to scientists or universities - they are probably more liberally biased than doctors are! Most of them are a huge waste of time and money.

Heh, no, I have never worked on a clinical trial; if I did, I guess you'd write me off as an untrustworthy lib'rul scientist. [Two out of three, I'll admit to.] Yes indeed, kidneys and breasts ARE two different organs. The point was that not every drastic, destructive, and expensive thing done to "try to save lives" actually saves any lives at all. In fact, the early positive reports on bone marrow transplants for breast cancer turned out to have been deliberately faked. By a doctor. For profit. He was South African, but if he'd been a U.S. Republican, would you really rather trust him than the results of a study that has multiple co-authors and examines data from thousands of patients?

U.S. Republican? What in the world does that have to do with anything?

Jane... grow up. I do not trust studies because I have actually conducted them - they are usually started by some "scholar" or "scientist" trying to suck money out of our government so they don't really have to work at anything. Very altruistic and sometimes accidently beneficial, but not the greatest use of our money eh? Kinda like gambling... no way to know when or if you'll win.

Some studies are probably worth the expenditure - but most of them are just junk scientists trying to justify their job.

It might have been more interesting if a correlation could be established between cause of death and kidney removal. It is expected that the older you get the higher probablility that you will soon die. Does that mean you cut off treatment at a certain age because "they ain't gonna be around that much longer"? I hope not... then we'll start having to justify treatment based upon whether you are an Obamanaut or not...

I worked with a gentleman in his 40's who had a kidney removed. The surgeon clamped the artery on both kidneys during the surgery. They left the clamp on the good kidney and sewed him up. Of course, by the time it was found, there was serious damage to the good kidney. His brother was a judge, so he had legal representation to get a good settlement from the hospital and doctors (it took awhile, but he was able to retire - he needed to, as he was in very poor health.)

This is one way to have a treatment that is worse than wait-and-see.

Wedge award for the day.

Since when is it a conservative dogma that "health care" should cost as much as possible and needlessly mutilate as many people as possible? I would think anyone of any party would want to know the facts if a doctor was trying to jam major surgery down their throats that was much more likely to kill them than to save them from future disease.

You should be quiet now. No one "jams" surgery down anyone's throat. Our surgeon would not operate until we completely understood the decision we were making. While we were not completely sure what was best (thanks to the misguided scientific community), it was definitely not the surgeons fault.

And cancer surgery to remove a kidney is not mutilation, is not more likely to kill the patient, and does not make them any more prone to future disease than keeping the cancer in their system would.

I should be quiet now, eh? Should the journalist who wrote the story have buried it? Should the researchers who analyzed the data have hidden the results? All because you don't want the cognitive dissonance that comes with knowing that your husband might never have needed treatment and might even have been better off keeping his kidney? Sorry, but ambiguity and uncertainty are part of real life. So, in many American doctors' offices, is pressure to hastily treat every abnormality that is detected, especially ones that are called "cancer."

Now I really think you should shut up.

All the tumors in this study were relatively small, under 1.5 inches; people with larger tumors were not included. Few of these people would have been "sick" as a result of their tumors. If they had other actual illnesses (or risk factors defined as illnesses) they would have been less likely to undergo surgery, not more likely. (If you already have a weak heart, you're likely to die of heart problems before you could possibly die of your little incidentaloma, therefore surgery is less likely to benefit you and the surgeon may not want to do needless surgery on someone who might die on the table and lower his stats.)

It is possible that some of these small tumors could be determined by non-invasive means to be more likely to be dangerous, motivating surgery. This could partially explain the fact that surgery did not even reduce the rate of death from kidney cancer (since those rare dangerous cancers probably spread even before they were accidentally discovered). However, plainly the majority of all people with small tumors, not just those few with dangerous-looking tumors, are encouraged (if not coerced) to have surgery. Only one-quarter of them refused, and 97% of those have not since died of kidney cancer, showing that refusing was a wise choice for that group.

leaded71 -

One thing you have to realize, this is the lay press. As in, the people writing it may have some minimal medical experience, but it is intended for an audience that generally reads around a 6th grade level. It is not intended for doctors or surgeons or anyone who either already knows their @!$%# or has the means to read and actually understand the study, this is mostly just a "huh, ain't that somethin'" bit that the writer would probably want to advertise as an informative conversation starter for patients who know @!$%#-all about the subject.

It's the same in science. Don't get me wrong, I really like the science writer here, but he doesn't go into extreme technical detail, even though he probably could, because his audience wouldn't get it. Sure, a few science nerds and professionals would understand, but that's not really a target audience, especially since they're more likely to go to the source papers for their information.

In other words, I wouldn't worry that a doctor is going to see this and say, "gosh, I'd better stop prescribing surgery for all my kidney patients." Doctors know better than to get their information from the MSM. This is for the rest of us, who might now want to get a second opinion if our doctor prescribes surgery. Sure, some people might read this and decide for themselves that they don't need surgery and die as a result. Then again, some patients might read this and decide they don't want the surgery and avoid all the horrid complications that can come of it and die two decades of something totally unrelated. It's a chance you always take, but my opinion is it's better to get the information you can.

Right now my renal function is about 25%. That's one-half of one kidney. I'm fine, although I have to take bp meds and watch my diet. Kidney function is very redundant - I recently met an older man (in his late 60's) who had given a kidney to his brother 30 years ago. He's doing just fine. I think for someone with normal kidneys, one is plenty. For someone with abnormal kidneys, whatever is making them abnormal is probably affecting both, so it doesn't really help much to have two. But yes, I wonder about that too, especially since my husband has promised me one of his when I need a new one...

My brother had to have a kidney removed when he was 18. He's now currently 63, and no problems so far.

Depends on the origin of the tumor and the specific histology of the tumor. e.g. a slow growing menengial tumor (very rare) will cause significant functional problems even when very small, whereas a fast growing sarcoma often won't cause symptoms until it's relatively large. Every cancer is unique both in terms of the tissue of origin, the specific genotype of the tumor and the individual patient.

Obamacare doesn't kick in until 2014 - makes it hard to believe the rest of your posting.

backtobasics: Your son can get health insurance through the Affordable Care Act. It isn't free but is reasonably priced based on age, not condition. He only needs to be uninsured for 6 mths or more and have a medical condition that would otherwise make one uninsurable or too costly. Check out the following link and get your son covered:

I agree. People (especially doctors) think that death is the ultimate enemy, but some things are MUCH worse. Quality of life trumps terminal suffering any day.

People (especially doctors) think that death is the ultimate enemy

yes because then all future income opportunities/ payments cease.

yes because then all future income opportunities/ payments cease.

Doubt that's the case. After all there's always more out there. It's not like we're going to run out of sick people any time soon.

I think the slow growing tumors are of danger to a younger patient like your husband. I am happy that he's feeling good.

People who are in pain and peeing blood are actually sick and need treatment. The question is what to do about asymptomatic tumors that are accidentally diagnosed when someone gets a scan [that they may or may not have needed] for some unrelated purpose. If we all went and got a bunch of CAT scans, most of us would have some alleged abnormality. Ignoring them can be the smartest thing to do. If you're not sure whether to worry or not, as you say, figuring out whether a lump or spot is growing and how fast can be a good idea. But that is exactly what monitoring does. Those who were rushed to have the thing chopped out as soon as it was found can never answer that question. Human nature being what it is, most of those who haven't died are no doubt going around telling everyone that they'd be dead by now if it weren't for that lucky test.

I think the question is, do we wait for them to suffer as I did before they are treated. Let's just not be too hasty with this.

I was diagnosed with a cancerous tumour on the right kidney and subsequently went though surgery last year in November 2012. After the operation the oncologist has put me on sutent sunitinib of four cycles @ 28 day with a two week break. The side effects of the capsule has been something else. I have never felt pain like this. There is lightning of the skin particularly on the face. My gums are swollen and I cant open my mouth. This means I am having difficulties eating. I have stomach attacks which are sometimes severe and not to mention diarrhoea. I have blisters on my feet. This is my second cycle and I do not have any doubt that these are side effects of the capsules. The pain is sometimes so sever to the extend that I am wondering the wisdom of this treatment. My feeling is that monitoring is the best option. The only problem that I see is that the doctors say that this decease is very difficult to diagnose. Discovery on my part was because of a scan that was taken.I have gone 21 days on a new cycle with 7 days to go. I just feel like quitting. I wish to share experiences with people who have either gone through what I am going or those that are taking this treatment

Yes, I agree Kev... these decisions should be made by the patient and his choice(s) of doctors.

Yankee Boy

Why not go and get a second opinion from another urologist? Bring your records with you. It may be an added expense, but may help you in deciding what to do. I was 43 when I was diagnosed with kidney cancer; I was asymptomatic but the tumor was about 4.8 cm by 3.2 cm. Surgery was recommended by a urologist, bit I was fortunate enough to have a good friend who was also an urologist; he agreed that surgery was indicated. It is now 14+ years since I have been living with one kidney, but my remaining kidney is working like a charm.

Unless you have a genetic or other underlying kidney disorder that may affect your other kidney, a kidney is a remarkable organ and only one can keep you just as healthy; just watch the salt.

Best wishes to you!