Father just diagnosed with RCC

[ERdoc]

Hey guys...my father was just diagnosed about 1 week ago with RCC via a dedicated renal CT after complaining of some back pain. Anyways the mass is like 6x7x8cm and they are planning to do a radical nephrectomy this coming Thursday. So far his abdominal CT and CXR have all come back negative. My question is is there anything else we should do, for instance is it worth getting a second opinion? What are the chances this is a benign oncocytoma-does it still need to be removed? Should we talk with any oncologist before surgery? Also does he need any other imaging to make sure there is no metastases (Full body CT)?

Again we've already been to the urologist and I was just seeking additional advice perhaps from any attendings or residents on here.

Thanks in advance everyone!

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[gudog]

Hey guys...my father was just diagnosed about 1 week ago with RCC via a dedicated renal CT after complaining of some back pain. Anyways the mass is like 6x7x8cm and they are planning to do a radical nephrectomy this coming Thursday. So far his abdominal CT and CXR have all come back negative. My question is is there anything else we should do, for instance is it worth getting a second opinion? What are the chances this is a benign oncocytoma-does it still need to be removed? Should we talk with any oncologist before surgery? Also does he need any other imaging to make sure there is no metastases (Full body CT)?

Again we've already been to the urologist and I was just seeking additional advice perhaps from any attendings or residents on here.

Thanks in advance everyone!

Will try to answer your questions in the order you asked them.

Second opinion - only if you want someone else to do the operation. I don't think anyone would argue against nephrectomy for an 8cm tumor. Few, if any, 8cm tumors are amenable to partial nephrectomy.

Oncocytoma - this is a diagnosis that can only be made after resection, unfortunately. Needle biopsies cannot differentiate between carcinoma and oncocytoma in this situation. Anyway, an 8cm oncocytoma needs to be removed. There is about a 10% chance of oncocytoma, by the way.

Oncology opinion - Primary treatment of renal cell carcinoma is resection. The only help oncologists provide in RCC is the treatment of recurrent/metastatic disease, so no medical oncology opinion is needed preop.

Metastatic W/U - Your dad has had all the metastatic workup needed at this stage. I only do more detailed workup (bone scan, chest CT, etc.) if I am looking for a reason not to operate, ie multiple comorbidities that would make the operation riskier than normal.

You are welcome to PM me if you have any further questions.