We got up very early this morning and drove into Seattle for John's second opinion. After reviewing the latest CT and PT scans, this urologist confirmed that John has more than a 90% likelihood of having renal cell carcinoma. In addition, he concurred that John needs to have his right kidney totally removed because the cancer is quite large.
This urologist, however, did not agree that the swollen lymph nodes next to John's liver need to be biopsied or removed. In this doctor's (and a colleague's) experience, kidney cancer does not typically spread to lymph nodes near the liver. Also, these swollen lymph nodes did not show positive for cancer on a PT scan. That is, the lymph nodes do not look "clinically suspicious" enough to warrant the risks associated with an invasive surgical procedure.
Furthermore, if a lymph node biopsy did showed positive, then cancer cells are very likely already throughout John's body anyway. This urologist explained that new drugs show promise at shrinking metastasized kidney cancer, but they don't do well when it has only spread to the lymph nodes.
But, before this urologist firms up his "official" second opinion, he wants to thoroughly review all of John's radiology scans, including those from 2007. So, we should hear back from him in a few days.
If John decides to go ahead and get the lymph nodes next to his liver removed, it'll mean an invasive surgery with a large chevron incision on his abdomen. If he decides to leave the lymph nodes intact, the right kidney will likely be removed using laparoscopic surgical methods. Laparoscopy is less invasive, reducing both hospital and recovery time significantly, as compared to the use of a chevron incision.
Regardless of his choice of surgery, John will follow up with regular scans to make sure the cancer has not spread.
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