Active Surveillance

This is the least invasive treatment option for small kidney tumours (less than 4cm), which are less likely to be aggressive.  Rather than treating the tumour immediately, it is observedover time using regular ultrasounds or CT scans.  If the tests suggest that the tumour is growing at any time, treatment will commence.

In addition to a small tumour, several patient factors make this an attractive option:

• Patients with poor kidney function.  Since any intervention on the kidney can cause further deterioration of kidney function, these patients may be better off selecting active surveillance. In some patients, further decline in kidney function puts the patient at risk of needing dialysis.  Dialysis, while life saving, may be associated with poor outcomes and a low quality of life. 
• Patients with hereditary forms of kidney cancer.  This includes patients with Von-Hippel-Lindau (VHL), Birt-Hogg-Dube (BHD), or other conditions in which patients are at risk of having multiple tumours on both sides.  These tumours are typically placed on active surveillance until they reach 3cm or larger.
• Patients who have drug eluting heart stents and need to be on a blood thinner. Kidney surgery/intervention can result in severe bleeding in these patients and thus a period of active surveillance until they can come off the blood thinners may be helpful to avoid a potential serious complications.
• Elderly patients who are medically fragile. Since the risk that the small kidney tumor spreads is low, in patients with a short life expectancy (<10years) a discussion regarding active surveillance may be prudent. Many of these patients die WITH the kidney tumour rather than OF the kidney tumour.
• Patients who are experiencing or recovering from an active serious medical problem. A period of active surveillance until things stabiliseshould be entertained.
• Patients who are extremely anxious about having surgery or do not wish to have treatment.

What does active surveillance entail?

Typically imaging is advocated every 3-6 months for 2 years then every 6-12 months annually. The initial evaluation should include a complete staging evaluation (blood work, chest/abdomen/pelvis imaging) to exclude the possibility that the disease has already spread. CT or MRI is preferred for the initial evaluation and then alternate between CT, MRI, and Ultrasound to minimise radiation to the patient and to comprehensively evaluate the tumour. The exact protocol is customised to the patient.