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Paul's Kidneys will be Saved
Paul B. has only one kidney which has a 4.5 centimeter tumor, in a bad place, in the center of the organ. This cancerous tumor is caused by von Hippel-Lindau syndrome.
When La Presse met him, last week, at the Notre-Dame Pavilion at the University of Montreal Medical Center (UMMC), Paul was in good spirits and was preparing himself for one of two outcomes:
The first: an operation to be done at UMMC to remove the affected kidney. This would mean dialysis once every two days for the rest of his life.
The second: an invitation to join the research program at the National Cancer Institute (NCI) in Bethesda, Maryland, as his brother had done several years before. At NCI, specialists in VHL have been perfecting over the last ten year a delicate operating technique capable of preserving the kidney. Paul sent to NCI a copy of his medical report in the hope at least of a second opinion, and at best an invitation to join the program. Wednesday he had his reply: he was invited to join the program. He would have his operation the following Thursday.
"The doctor at NCI told me that they had seen much worse cases than mine, and that they would be able to preserve the kidney," says Paul. "It is reassuring to feel that they have lots of experience." Two weeks before Paul was admitted through Emergency at the Notre-Dame Pavilion of UMMC. The excruciating pain was caused by a clot that was blocking the ureter, the conduit between the kidney and the bladder. The tumor had bled.
Dr. Serge Carrier, urologist at Notre-Dame, agreed with his patient's idea of joining the NIH program, where surgeons have much more experience with partial removal of the kidney.
Surgeons are trained to remove an entire kidney that has a cancerous tumor. If only one kidney is affected, one can cut it like an apple to remove the affected part.
"In the case of ordinary kidney cancer, the risk of developing another kidney cancer tumor is between 10 and 15%," explains Dr. Carrier. "We prefer not to run this risk but to remove the entire kidney. We may still choose to remove only part of the kidney if they other kidney is missing, or in the case of von Hippel-Lindau."
At NIH, the research doctors have for the last ten years pursued a third strategy, which consists of delicately removing each tiny tumor in order to preserve the maximum amount of healthy kidney tissue. They rely on the fact that under a size of 2-3 cm. in diameter the tumor is too immature to cause another tumor. This strategy requires careful follow-up.
"It is this strategy that allows us, it is nonetheless true that choosing an operating strategy for a kidney is a very complicated decision," says Dr. W. Marston Linehan, Chief of the Urologic Oncology division at the National Cancer Institute in Bethesda. "It depends on the size and placement of the tumor, and the feelings of the patient and doctor about dialysis, and the risk of another cancer. Each option is discussed with the patient before one decides on a treatment plan. Even though we want to preserve the kidney, there are cases where it has to be removed."
Read the full spread of articles on VHL from La Presse, 29 March 1998:
The French original: Une belle vie, grâce à Internet et à la recherche mystory |
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