Active Surveillance

Dr. Eric Kauffman discusses active surveillance for kidney tumors.

What is Active Surveillance for Kidney Tumor?

Active surveillance is an approach to a kidney tumor (or mass) in which the tumor is watched closely, and treatment is initiated only if certain features or changes are identified. Because many kidney tumors are either benign, or low-risk cancers with small size and slow growth, we are finding that many kidney tumor patients can safely delay treatment – or not undergo treatment at all – and instead opt for careful monitoring with a biopsy and periodic CT scans once or twice a year.

Kidney tumors are unique in that the decision to undergo surgery to remove the tumor or mass is often made without knowing whether the tumor is actually cancer. Roswell Park has developed an approach to determine definitively whether a mass is benign or malignant, saving patients who do not have cancer from unnecessary surgery.

Active surveillance should be managed by a multidisciplinary team of kidney cancer experts – urologists, radiologists and pathologists – with the experience to detect and appreciate the subtle changes in the tumor that trigger a need to initiate treatment. “This requires not just skilled physicians, but timely and ongoing communication among them, for every case,” says Roswell Park urologist Eric Kauffman, MD. At Roswell Park, active surveillance is a first-line treatment option for many patients with low-risk kidney cancer.

Why Would I Consider Active Surveillance?

A patient with low-risk kidney cancer may face a greater risk from the cancer treatment and its side effects than from the cancer. A kidney tumor is not life-threatening unless it develops the ability to spread beyond the kidney. For kidney cancer, that ability to spread is very closely related to the tumor’s size. Many small, low-risk tumors will never grow large enough to do this.

In addition, the primary treatment – surgery to remove the tumor or the entire kidney – carries some risk for complications such as bleeding, internal urinary leakage, or (rarely) serious life-threatening events. Even successful kidney surgery can result in diminished kidney function. Therefore, it’s important to weigh the risk of serious complications against the risk of your tumor spreading; often the latter risk is lower.

How would my cancer be monitored?

The surveillance of your cancer means you would undergo routine computed tomography (CT) or magnetic resonance imaging (MRI) scans every 6 to 12 months. Another needle biopsy of your tumor would be taken if the tumor reaches a certain size at which spreading might occur. You would also meet with your oncologist every 6 to 12 months to discuss any new symptoms or changes in your tumor’s size and appearance. 

Rarely, some subtypes of kidney cancer may be able to spread at a smaller size and even a small change in the tumor can be a red flag and signify the need for treatment. On the other hand, many smaller kidney tumors are actually benign and not cancerous or life-threatening, even if they continue to grow. A biopsy can help determine whether a tumor is benign or a certain subtype of kidney cancer but is challenging to perform and interpret. Therefore, it’s very important that radiologists and pathologists with specialized expertise in kidney cancer determine your exact diagnosis.

When Would I Convert to Treatment?

Your cancer care team would recommend beginning another treatment approach, such as surgery, ablation or medications if your cancer:

  • Begins to grow larger
  • Begins to grow faster
  • Shows certain cell characteristics in a biopsy

Am I a Candidate for Active Surveillance?

About half of all patients with kidney cancer have tumors that are small enough – about the size of a strawberry or small plum – to be considered low risk. Patients with larger tumors may also be considered for active surveillance if the surgery poses a greater risk for them than the tumor.