Active surveillance is a form of treatment for localised kidney cancer in which the doctor actively monitors the tumour. It is recommended if surgery is not the best option for you and you have a tumour in your kidney which is smaller than 4 cm.
Some of the reasons why your doctor may say you are unfit for surgery include your age or any medical conditions which make surgery dangerous for you. To determine if active surveillance is an option, your doctor may want to perform a renal tumour biopsy. The tumour tissue taken during biopsy is analysed to make sure it is not aggressive. If the tumour is aggressive and surveillance is not an option for you, you may be recommended further treatment.
If you are a good candidate for active surveillance, your doctor will set up a strict visiting schedule. On each visit, the urologist asks questions about any noticeable changes in your health, performs a physical examination, and discusses the results of your blood tests. Before each visit, you get a CT or an ultrasound scan of your abdomen to monitor the growth of the tumour. An x-ray of your chest may also be done to check your lungs.
In most cases, a follow-up visit is needed every 3 months in the first year after diagnosis. In the following 2 years the visits are scheduled every 6 months, and then once a year.
In general, small kidney tumours tend to grow slowly and the cancer rarely spreads to other organs. If tests during follow-up show that the tumour is growing fast, or if you develop symptoms which may indicate the disease is advancing, the urologist will immediately plan further treatment.
Options for further treatment include surgery to remove the tumour or the whole kidney, or ablation of the tumour by cryotherapy or radiofrequency ablation (RFA).
Factors which influence the decision for the best treatment option include:
- Your age
- Other medical problems you may have
- The location of the tumour
- The subtype of the tumour
If surgery is selected, partial nephrectomy should be favoured whenever possible. During this surgery, the tumour is removed but the surgeon leaves as much as possible of the healthy tissue of the kidney intact.