From the Guidelines
The next step for a patient with a re-demonstrated left renal mass in the midpole should be a comprehensive urologic evaluation, including referral to a urologist for further assessment and management planning. The urologist will likely recommend additional imaging such as a dedicated renal protocol CT scan or MRI if not already performed, to better characterize the mass and determine its size, enhancement pattern, and relationship to surrounding structures 1. Laboratory tests including complete blood count, comprehensive metabolic panel, and urinalysis should be obtained, as recommended by the American Urological Association guidelines 1.
Depending on the size and characteristics of the mass, the urologist may recommend one of several approaches:
- Active surveillance with serial imaging for small masses (typically <3 cm) with benign features
- Percutaneous biopsy to determine histology
- Definitive treatment which could include partial nephrectomy (preferred for localized tumors to preserve renal function), radical nephrectomy, or ablative therapies such as radiofrequency ablation or cryoablation 1.
The management approach depends on multiple factors including tumor size, location, patient age, overall health status, renal function, and patient preferences 1. Prompt evaluation is important as renal masses can represent renal cell carcinoma, which has better outcomes when treated early. It is essential to consider the patient's general health, comorbidities, oncologic potential of the mass, and pertinent functional issues during counseling and management 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Next Steps for a Patient with a Re-Demonstrated Left Renal Mass
The next steps for a patient with a re-demonstrated left renal mass in the midpole involve careful evaluation and consideration of various management options.
- Imaging Characterization: The first step is to characterize the renal mass using imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI) 2, 3. This helps to determine the nature of the mass, whether it is benign or malignant, and its size.
- Biopsy: If the mass is indeterminate on imaging, a biopsy may be necessary to determine its nature prior to definitive treatment 2, 4. Biopsy can help differentiate between benign and malignant tumors.
- Management Options: Management options for malignant or presumed malignant renal masses include active surveillance, percutaneous ablation, laparoscopic or open, partial or total nephrectomy 2, 5. The choice of management option depends on the size and location of the tumor, as well as the patient's overall health.
- Nephron-Sparing Treatments: For small renal masses, nephron-sparing treatments such as radiofrequency ablation (RFA) may be considered 5. RFA is a minimally invasive procedure that can help preserve renal function.
- Follow-Up: Regular follow-up is essential to monitor the patient's condition and detect any changes in the tumor 5, 6. This may involve periodic imaging studies and physical examinations.
Considerations for Small Renal Masses
For small renal masses, it is essential to consider the following:
- Size and Location: The size and location of the tumor can influence the management option 4, 6.
- Imaging Features: Imaging features such as CT attenuation, border, and shape can help characterize the mass 6, 3.
- Benign vs. Malignant: Differentiating between benign and malignant tumors is crucial for determining the appropriate management option 4, 3.