Treatments for Kidney Cancer in Dallas-Fort Worth

Simple Cysts (Bosniak I) are “simple” water-filled bubbles in the kidney. They do not have any internal structure. They are typically perfectly round. They can be very small (1/8 inch) or they can be very large (up to about 8 inches). They are typically not associated with any pain or symptoms. They are not cancers and they do not turn into cancers. They almost never need any kind of treatment or surgery. They are sometimes monitored with additional imaging tests to see if they are changing or growing over time. Rarely, the fluid might be drained from the cyst. This is typically done by a radiologist under light anesthesia. This procedure might be performed to tell whether the cyst is causing pain. If a simple cyst is thought to be causing pain or blockage of the urinary tract, laparoscopic surgery may be recommended to remove the top of the cyst. This is called laparoscopic cyst decortication.

Hemorrhagic/Proteinaceous Cysts are a specific type of “complex” cyst that contain either blood or a thicker protein fluid inside. These cystic masses are not cancers and do not require surgery. They do typically need to be watched with repeated imaging tests.

Complex Cysts (Bosniak II, III, IV) are cyst-type masses that have some internal tissue or structure. This category of cysts is named after the radiologist who first suggested classifying them into different types—Dr. Morton Bosniak. The Bosniak type is typically decided by the radiologist and urologist after reviewing a CT or MRI with contrast injected into a vein. The Bosniak types are:

Bosniak II and IIF Cysts Bosniak II and IIF Cysts are the least complex of all the “complex” cysts. This type of cyst may contain some calcium and have internal walls called septations. While the septations do not have measurable blood flow inside them, the cyst walls may be a little thicker than the walls of a “simple” cyst. Almost always benign (non-cancerous), they rarely require surgical removal, but may be monitored with additional imaging tests over time.

Bosniak III Cysts Bosniak III Cysts have several internal features that separate these cystic masses from “simple” or other “complex” cysts. They can have thicker walls and some of the walls may show blood flow inside them on the imaging test. As many as half of these can be cancer. These cysts can sometimes be observed with additional imaging tests, although many of them will need to be removed surgically. If the cyst is removed and found to be cancer, almost all patients are cured and do not need any additional treatment.

Bosniak IV Cysts Bosniak IV Cysts are the most complex type of cystic masses. These lesions typically have a solid portion that has blood flow inside it. Most of these lesions are removed surgically, and determined to be cancer after they are removed. After surgery, almost all patients are cured and do not need any additional treatment.

Most solid masses in the kidney that take up injected contrast agent will eventually be found to be cancer. That does not mean all solid masses are cancer. Sometimes an X-ray report will say a kidney mass is kidney cancer. However, a scan cannot diagnose cancer. The only way a mass is determined to be cancer is through a biopsy (the examination of tissue under a microscope). There are two main types of kidney cancer: renal cell cancer and transitional cell cancer.

Renal cell cancer is the most common diagnosis in patients with a solid-enhancing mass. However, unlike many cancers, renal cell (kidney) cancer is curable in most cases. Surgery is usually the only treatment a patient will need in order to be cured. Most patients do not need chemotherapy, radiation therapy or immunotherapy. The prognosis for a patient with kidney cancer depends on the grade (the measure of how aggressive the cells are) and the stage (how far the cancer has spread).

Two types of solid masses are associated with renal cell cancer: oncocytoma and angiomyolipoma.

Oncocytoma is a solid-enhancing mass that often looks very similar to kidney cancer on imaging, but is actually benign. Neither CT, MRI or ultrasound can reliably diagnose an oncocytoma from a kidney cancer. If a patient has a needle biopsy that shows oncocytoma, their mass may be monitored over time with additional imaging tests; however, surgery may still be needed.

Angiomyolipoma is a solid-enhancing mass that is benign. It is made up of abnormally placed blood vessels, muscle and fat cells. Some imaging tests may show large areas of fatty tissue. If this is present inside the mass, the diagnosis is typically made without a biopsy. Most of these masses can be safely observed with additional imaging. Large masses or masses that are irregular in shape may still need to be biopsied or removed with surgery.

Transitional cell cancer of the kidney or ureter is a cancerous mass in the urinary tract part of the kidney or in the tube that drains the kidney (ureter). It is sometimes referred to as urothelial cancer, renal pelvis cancer or ureter cancer. This cancer is the same disease often found in patients with bladder cancer, and can be more aggressive than renal cell cancer. Small tumors may be treated through telescopes in the urinary tract (ureteroscopes) using either laser or cautery to destroy the cancer cells. However, most masses require surgery to remove the kidney and ureter tube (robotic nephroureterectomy).