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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Persistent severe cough, chest X-ray showed gland, had radical right nephrectomy for renal cell carcinoma, want to know whether gland is related to cancer. Advice?

Hello doctor, Note: my dad has undergone a major rdical right nephrectomy by 2009 My dad had been to Sri Ramakrishna hospital this morning in coimbatore, he has been complaining of cough since 1.5 months. He had been advised by the doctor at Sri ramakrishna to take a x-ray before any further diagnosis. The doctor has found a GLAND in his chest x-ray . and hence he has been asked to undergo futher tests like blood test, CT scan and Cardio . We heard from lab technician that cardio is appearing normal which has now lessen our worries by 10%. But we are more worried because my dad is a Cancer patient who had undergone a major surgey in 2009. He was detected with Renal cell Carcinoma and had undergone Radical right nephrectomy and partial left nephrectomy. Since then, he has been under constant checkups and they appeared normal with no further cancer growths. Could you please help us with the below queries 1. Is gland something related to Cancer? 2. If so, is it curable Thanks for your time on my query. Regards loving daughter
Fri, 10 May 2013
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Pulmonologist 's  Response
hi
thanks for ur query and detailed history
see ur dad had a RCC and radical nephrectomy following that
and to be frank there is high chance of metastasis to the lungs
so answer to ur first qn is yes there is probability of having cancer but before that its needed to confirm that by following-
1. CECT thorax and guided FNAC if reachable
2. FOB with TBNA if possible and also to look for intraluminal growth and if found take biopsy for that
3. if above two failed then thoracoscopy guided mediastinal lymphnode sampling and biopsy
i think diagnosis ll be made by these procedures
keep in mind there is also chance of tb, other cancer as well
ans to 2nd qn
if so then probably it ll not be curable..in that case chemotherapy ll be of help
consult a pulmonologist
thank u
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Urologist Dr. Srivatsa Narasimha's  Response
      Hi,

Lesion in Chest following radical nephrectomy and a partial nephrectomy on the
other side is most likely to be metastatic.

A CECT of the chest would generally suffice to ascertain the nature of lesion and
provide us with a working diagnosis most of the times.

Rarely, a CT/Bronchoscopy guided biopsy could be considered if the lesion in
question looks doubtful of being metastatic.

more accurate than a CT scan would be to subject your father to a FDG PET CT. PET
CT is highly accurate in diagnosing metastases from kidney cancers.

The advantage of having a PET CT in your father is that not only will it obviate
the possible need for a biopsy, it will also pick up other metastases if any, as
small as 3mm leading to better staging of his condition.

accurate staging at this point of time will have therapeutic implications.

Metastatic disease in Renal cell carcinoma is still not very disheartening unlike
many other cancers as cure could still be achieved by resecting the recurrent
lesions if technically possible ( single metastatic deposit or confined to one
area of lung/liver, for instance).

Do not worry. there are many drugs available now which can push the disease into
remission for prolonged periods of time, which is most likely to be so in your
father's case considering almost 3+ years taken for the cancer to come back(if it
really has).

Best Wishes,

Srivatsa
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General & Family Physician Dr. Pavan Kumar Gupta's  Response
Hello
This could be cancer.
If this is cancer then most likely it is a metastasis from renal carcinoma.
Once cancer metastasize then there is no permanent cure.
Get the required investigations done so that diagnosis is made.
Thanks
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