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What Does Removal Of A Bit Of Kidney In Colon Cancer Surgery Indicate?

Posted on Mon, 28 Apr 2014

Question: Can I spk to a radiologist . My dad had his surgery yest re Colon cancer. The tumor was removed and they said a very small bit of the bottom of kidney removed also to send pathology. Does the cut mean tumor invaded kidney?

Answered by Dr. Vivek Chail (5 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in to us. I have read through your query in detail. Cancer is a condition which must be treated aggressively. It might have happened that the operating surgeon found the cancer area of colon adherent to the lower pole of kidney. Under such circumstances it is best to excise part of the kidney and then send for complete histopathological analysis. There is a possibility of the cancer infiltrating the capsule and fat surrounding the kidney or the kidney itself. It would be essential to have a look at the pre operative CT scan images or report before commenting on the possibility of kidney infiltration. The surgeon has taken out part of kidney to make sure if there is any spread including microscopic invasion (which may not be seen on CT scan). The pathology report can change the staging of cancer and also the treatment course. Hope your initial query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (5 hours later)

Plz find the ct report attached of feb. So the reason they cut bit off was for testing? But what if there is microscopic spread ? Then shud whole kidney not have been removed?

Answered by Dr. Vivek Chail (10 hours later)

Brief Answer: Please find detailed answer below. Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. I have read through the CT report in detail. It is clearly mentioned that on an earlier occasion, there was a clear demarcation between the cancer and right kidney which is described as fat plane intact. In the present scan there is extension of the tumor into the kidney capsule and probably the kidney too at its lower pole. The surgeon has used his knowledge in taking out part of the kidney. The entire kidney is not always to be sacrificed in such circumstances. They will test the cut portion of kidney for any macroscopic or microscopic invasion and look for advanced disease. I suppose the nodes were also removed to analyse for nodal spread. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (37 minutes later)

Yes nodes removed to check too . What does it mean on report by small volume lymph nodes keeping in line with tumor? That means they r not enlarged But could it still be that kidney not affected, or you think it will be due to loss of fat plane??

Answered by Dr. Vivek Chail (16 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. Presently there is increased contact between the kidney and tumor. This suggests that the cancer may have infiltrated the kidney capsule. The surgeon might have tried to separate the tumor from the kidney if possible but had to excise the kidney as separation was not easy. I feel the kidney capsule was infiltrated by the tumor but biopsy results will be final. The nodes are not extensive. Here we have to keep in mind that individual nodes have to be studied under the microscope for cancer cells. Nodes may not get much enlarged if they are involved by the cancer and each node must be evaluated. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (3 minutes later)

Thx. So if kidney capsule infiltrated is this diffetent to cancer in the kidney?

Answered by Dr. Vivek Chail (14 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. You are welcome. Kidney capsule is closely adherent to the kidney just like some object is tightly packed with adhesive tape. To our eyes, it is difficult to exactly say if the caecum cancer was limited by the kidney capsule or if it had microscopically invaded it and spread to the lower pole of right kidney. The surgeon has taken a decision based on good judgement regarding how much of the lower pole of kidney is to be cut and sent for biopsy. He has kept some safe margin to be sure that the remaining portion of right kidney is free from cancer spread. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (7 minutes later)

Oh ok. Then with chemotherapy would prognosis be good? What do fat stranding small volume lymph nodes mean?

Answered by Dr. Vivek Chail (16 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. Chemotherapy is necessary to control the cancer should it still remain following surgery. The final staging of cancer will depend on biopsy findings. Prognosis is always good in most patients who get chemotherapy. Lets hope that your dad tolerates chemotherapy sessions well and remains complication free during treatment. Fat stranding means that the cancer has started to spread to the structures surrounding the cecum. Cancer causes neoangiogenesis (new blood vessel formation) and involvement of tissues around the cancer. Fat stranding is seen due to this. Small volume lymph nodes refer to the less extensive lymph nodal involvement. It needs further confirmation by biopsy as to how many of the lymph nodes taken out are actually showing presence of cancer. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (58 minutes later)

Sorry to keep asking but the repor states fat stranding small volume lymph nodes keeping in line with tumor. So could the lymph nodes poss not b affected?

Answered by Dr. Vivek Chail (14 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. The words "fat stranding small volume lymph nodes keeping in line with tumor" mean that the fat stranding and small volume lymph nodes that are seen can be related to be due to the tumor. In simple words, the fat stranding and lymph nodes are as expected and do not come as a surprise. Having worked in a specialty cancer institute and reported many patients as your dad, it is unlikely to me that the nodes are not affected by the tumor. Though hypothetically it can be possible for no nodes to be affected in a small tumor, it is most likely that at least some of the nodes might be affected (considering the tumor and its adherence to the right kidney) and that will be confirmed by biopsy. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (33 hours later)

Hi my dad had surgery wednesday but we hav noticed that he seems a little confussed at times and instead of hard stools he just passing watery. Is this normal?

Answered by Dr. Vivek Chail (6 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. His confusion might be because of weakness after the surgery. His electrolytes levels need to be checked regularly as low sodium, potassium and chlorides must be ruled out. The stools will remain altered for a while and this is because a segment off the cecum was removed. As time progresses the wound will heal and his stools will also improve. Please follow necessary dietary advice. I hope your dad is able to make slight changes in his position in the hospital bed every two hours. This is important to prevent deep vein thrombosis which is a possible and avoidable complication in patients who have had surgery. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (4 hours later)

We were worrief that could he hsve a leak?

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer: Please find detailed asnwer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. Your doctor will give instructions on how to support the operative site during deep breathing and coughing. Pain relievers are also given as felt necessary. The operative site is observed for color and amount of wound drainage.Usually feeding begins with liquids and advancing to a regular diet as tolerated within a few days. Any symptoms like continuous soiling of surgical wound dressing, worsening pain, abdominal distension and fever need to be assessed carefully. This may indicate anastomosis leak. If your dad has no such symptoms then there is no need to worry. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (14 minutes later)

He dont have fever but hardly been able to eat and getting lot pain near surgical site

Answered by Dr. Vivek Chail (1 hour later)

Brief Answer: Essential nutirents are a must Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. If there is no fever then no need to worry for any infection. Pain will be felt as its a big surgery. Pain medications may have to be increased in dose. If there is difficulty in eating, please discuss with nutritionist and provide him fluid diet for some more time. Mainly electrolytes need to be regularly replenished along with essential nutrients. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (8 hours later)

Is it normal for my father to feel severe pain near and arond the surgical site 5 days post operation ?

Answered by Dr. Vivek Chail (9 hours later)

Brief Answer: Pain can be moderate to severe Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. Pain is a relative sensation. While some people may be able to cope with severe pain while others may get really disturbed by pain. Since your father has had a surgery requiring removal of colon, pain will be there around the surgical site even after a week. It also depends on the length of incision, fluid collection in surgical drain, number of stitches etc. Pain can be minimized by informing your doctor and taking proper dose of pain killers. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (5 hours later)

Should we worry about his confussion?

Answered by Dr. Vivek Chail (33 minutes later)

Brief Answer: Please see detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. There are patients who appear in confusion because of heavy sedation. Another common reason is low glucose and electrolyte levels. The doctors must be made be aware of this though its most likely that they know it. Persistent confusion and disorientation if present must be brought to the notice of health care givers at the earliest. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (23 minutes later)

Its not all the time but atleast few times a day that why we are worried.could it be anything else more serious?

Answered by Dr. Vivek Chail (5 minutes later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. If its not all the time then it looks less serious. I would like to know what exactly you mean by confusion, does he not recognize you and other close family members and does he feel he is not in the hospital or is it something else.. The main factors to monitor are his pulse, blood pressure, temperature and respiration and awareness. If these are in normal limits then its unlikely to be a serious condition. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (9 hours later)

Is there any way of knowing whether the full camcer has been removed and there is No further cancer in body? By confussion i mean once he thought he had his brother come to visit him when he really did not, one day he said hes been in hospital 15 days ( when only 5 days), today he said the man in the bed next to him Is gujarati when he is not. So things like that but he does understand and know everything. His bp, heart rate normal but is dehydrated. By confussion i mean he one day thought relatives came to visit when they really did not, the other day he thought he was in hospital 15 days, today he said someone in his ward fell when they did not really, and things like that. His bp and heart rate normal

Answered by Dr. Vivek Chail (5 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with your update. In my knowledge there are tests to check if there is any more cancer remaining after surgery but this cannot be done immediately. I am talking about PET CT scan where any trace of cancer activity can be picked up but this should not be done immediately after surgery as it can give false positive results. There are situations where patients can get disoriented because of dehydration and confinement to hospital bed for long durations but any psychiatric problems (post operative stress) need to be dealt with properly. If the confusion persists even a week after surgery then a psychiatry consultation might help in knowing his mental health status. However if he is likely to cause self harm (which looks unlikely) then you must get him evaluated immediately. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (28 hours later)

In your early reply u said you feel The nodes are not extensive from the ct report. What you mean by this ? Also if tumor infiltrated kidney capsule only, is this diffetent to infiltrating kidney? U have been v helpfull thank you so much .

Answered by Dr. Vivek Chail (10 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. Nodes in a suspected cancer can have various appearances. They can be seen in the area surrounding the tumor or can be seen in groups elsewhere. So having extensive lymph nodes can be large in size and number or in more than one location. In this context the lymph nodes in your father's CT scan were not extensive and confined to a certain area. The capsule is part of the covering of kidney and if tumor infiltrates it then the kidney might also be microscopically infiltrated. Hypothetically one can argue that can only capsule get involved but practically once capsule is involved the it doesn't take much time for the kidney to get involved, at least microscopically. I am glad to be answering your query. Hope your father is doing well. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (2 hours later)

Thank you so much . So if nodes are not extensive n confined to a certain area then is that A good sign?

Answered by Dr. Vivek Chail (6 hours later)

Brief Answer: Less lymph nodes are a sign of better prognosis Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. A disease with less extensive lymph nodes is in an earlier stage than a condition where extensive lymph nodes are involved. This means your father has a better condition by staging than any patient with extensive lymph nodes. Therefore surely a sign of better prognosis. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (5 hours later)

Hi could it mean that no nodes are involved at all possibly?

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer: Nodes likely to be involved in your father Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. In my experience, a tumor as described in the report of your father is likely to be associated with nodes. A tumor in earliest stages can possibly not involve nodes. Your father had a tumor which was not in very early stages. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (29 hours later)

Are you able to tell me what the staging will poss be? As they had to cut bit of the kidney the tumor is a t4 right?

Answered by Dr. Vivek Chail (5 hours later)

Brief Answer: Sate 3 c most likely Detailed Answer: Hi XXXXXXX , Thanks for writing in with an update. Its most likely stage III C as it fulfills the following criteria: Cancer has spread through the serosa (outermost layer) of the colon wall and has spread to nearby organs. Cancer has spread to one or more nearby lymph nodes or cancer cells have formed in tissues near the lymph nodes. Hope your query is answered. Do write back if you have any doubts. Wishing your dad a quick recovery. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar