What is Active Surveillance/Observation for Kidney Mass/Cancer?

Active surveillance is one of several treatment options for kidney cancer. Your urologist/cancer Doctor may recommend this option in certain situations as it is the least invasive treatment for kidney cancer. These terms ‘active surveillance’ and ‘observation’ are used interchangeably but there are important technical differences between them. Active surveillance tends to require a closer monitoring, both by patient and their medical team with more frequent clinic visits, labs and imaging scans like a CT scan. It is very important to clearly understand what your Urologist means when they are recommending this treatment option.

What is the benefit of Active Surveillance/Observation?

The obvious benefit of active surveillance/observation is that you can avoid immediate procedures (like kidney biopsy) or treatments like surgery to remove the suspected (or biopsy-proven) cancer. The length of time for which you could avoid such a treatment can be unpredictable. For some patients, no treatment is ever needed, while for others, a “trigger for treatment” is reached much sooner, sometimes within a few months.

Who is a good candidate for Active Surveillance/Observation?

National guidelines can change frequently and this information is for general purpose education only. Your Doctor and you will make a shared treatment decision based on your individual circumstances and preferences.

At this time, patients with kidney tumors (masses) less than 2 centimeters in size are ideal candidates for active surveillance due to the low likelihood that the cancer will spread while no treatment is being given; however, patients with tumors up to 4 centimeters can be safely watched based on a number of factors:

• If you have poor kidney function. Since any intervention on the kidney can cause further deterioration of kidney function, you may be better off selecting active surveillance. In some patients, further decline in kidney function puts them at risk of needing dialysis. Ask your doctor about your creatinine level, which is an indicator of kidney function (normal is less than 1.5 mg/dl).
• If you have certain hereditary forms of kidney cancer. This includes Von-Hippel-Lindau (VHL) syndrome, Birt-Hogg-Dube (BHD) syndrome or other conditions in which patients are at risk of having multiple tumors on both sides. These tumors are typically placed on active surveillance until they reach 3 centimeters or larger.
• If you have drug-eluting heart stents and need to be on a blood thinner. Kidney surgery/intervention can result in severe bleeding, and thus a period of active surveillance until you can come off the blood thinners may be helpful to avoid potentially serious complications.
• If you are an elderly patient who is medically fragile. Since the risk that the small kidney tumor spreads is low, if you have other medical conditions that can cause/expected to result in a short life expectancy (less than 10 years) a discussion regarding active surveillance may be prudent. Many patients who will fit this criteria will die with the kidney tumor rather than from the kidney tumor.
• If you are experiencing or recovering from an active serious medical problem. Your Doctor may recommend a period of active surveillance until things stabilize.
• If you do not wish to have treatment or have significant anxiety about having surgery/other treatment.

What are the ‘Triggers for Treatment’?

The decision on when to start treatment in your case will depend on your preference and clinical circumstances. The most common trigger for treatment is demonstrated tumor/cancer growth. As a tumor gets larger, the risk of having a cancer and a more aggressive cancer increases. The risk of spread for a tumor less than 2 centimeters is less than 1%. The risk is 1–2% for 3-centimeter tumors and 3–5% for 4-centimeter tumors.

Change in your clinical condition could also trigger a treatment. For example, a patient who was having a heart attack when their 2.5-centimeter kidney tumor was discovered has now recovered one year later and is fit for surgery. This now triggers a treatment.

What will My Role be in Active Surveillance/Observation?

Your role: Active surveillance/observation requires a major commitment on your part. Because there’s a possibility that tumor/cancer can grow and spread, you need to watch for any signs or symptoms that may suggest cancer growth. These include, but are not limited to: abnormal (unintended) weight loss, fatigue/lack of energy, chest pain, shortness of breath, bone pain, kidney pain, blood in urine, nausea/vomiting, abdominal pain, burning in urine, painful urination etc. If you have any new sign or symptom that is either moderate or severe, or does not resolve within a few days, seek immediate medical attention with your medical team. If in doubt, it’s always better and recommended to contact your medical team immediately. You should also keep all recommended appointments as below.

Your Doctor’s role: The initial evaluation usually includes a complete ‘staging’ workup (bloodwork, chest/abdomen/pelvis imaging) to check if the disease has already spread. Typically, you will then be asked to undergo imaging scans (such as a CT scan, ultrasound, or MRI of your abdomen and other body areas) every three to six months months for two years then every six to 12 months annually. The exact protocol is customized to the patient.

Can the Tumor Spread while on Active Surveillance?

The answer to this is unfortunately YES. However, for a well-selected patient the risk of this occurring on surveillance is very low (less than 2%). Each patient and tumor are unique, and this risk should be discussed with your urologist.

Last revised: 02/25/2021 A