Dear Dr. Roach: I am 62 years of age and in excellent health. I run or hike three or more miles on most days, road bike, swim and weight train. I eat sensibly, and I don’t drink, smoke or take drugs. I don’t drink coffee or even take aspirin for pain. My last physical exam showed no problems, and my blood and urine tests were fine.
Recently, I was diagnosed with a small tumour inside my right kidney. It’s about a 2.5-centimetre solid mass with no rough edges at this time. The MRI showed “a 2.4 cm mildly enhancing solid mass concerning for a renal neoplasm.” It also showed that the left kidney has a single 1.2 cm cortical cyst over its upper pole aspect. Please explain what this means.
The options for treatment are to completely remove the kidney and see if it is cancerous or just monitor the tumour and see if it continues to grow and remove later. The doctor said the whole kidney has to be removed, because of the central location of the tumour.
The doctor also said a biopsy is not a good idea where the mass is located for fear of releasing cancerous cells within the kidney that could move quickly throughout the body. Removal is a drastic measure, no doubt, to test for kidney cancer.
Should I just monitor and wait to see what the tumour does or operate and have the kidney removed. What medical action do you suggest that I do?
I am sorry to hear about your kidney tumour. A solitary kidney mass in a man in his 60s is always suspicious for kidney cancer. A 2.4 cm tumour is large enough to provoke serious concern: In a recent study, in people who had their tumours removed, 83 per cent of tumours that size were kidney cancer.
Because of the location, a partial removal of just the mass is impossible, so the choice between watching and waiting versus taking the whole tumour out should take into consideration the very high likelihood that this is cancer. Kidney cancer can spread to other organs. If you were my patient, I likely would advise surgery. If you were not a good risk for surgery (say, in your 80s with multiple medical problems), then I might consider watchful waiting. In your case, I think going for surgery is the wiser course. Being so healthy will make your treatment much less risky.
Dear Dr. Roach: I have severe lower back pain and can’t stand up straight or walk very well. I saw a back specialist, and he took X-rays and reviewed an MRI. He informed me nothing could be done for me because I have diffuse idiopathic skeletal hyperostosis (DISH). I would like to know what this is and why nothing can be done for me.
DISH is essentially a disease of bone spurs. The ligaments and their attachments to bone themselves become calcified and bonelike. The cause is unknown. Symptoms are commonly back pain (more often, middle or upper back, not the lower back pain you have), but pain also may occur in the neck.
Problems with walking are not common, but can happen if a nerve is being compressed.
Surgery is not a usual treatment for DISH. It is occasionally necessary if the bone spurs press on nerves or if the bone spurs are so large that they interfere with eating.
That doesn’t mean nothing can be done for you. Physical therapy may be very beneficial; judicious pain medication and regular gentle exercise are the other effective treatments.
If the difficulty standing straight and walking persist, you should get re-evaluated.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.