Follow-Up After Kidney Cancer Surgery: How Often Are Scans Needed?

When kidney cancer has been removed, follow-up is how we make sure it stays away, and check the health of the kidney you still have. A common question is "How long do I need scans, and how often?" The honest answer is that it depends on what the pathology report says.

Key points

• Follow-up is planned by risk. Small, low-grade cancers need fewer scans than larger or higher-grade ones.
• Scans usually look at the kidney area and the chest, because the lungs are the most common place for kidney cancer to spread.
• Most recurrences are found in the first two to three years, but some happen later, so follow-up usually continues for at least five years.
• Blood tests check kidney function, which matters for the rest of your life.

What decides your follow-up plan?

Your pathology report is the guide. The most important parts are:

• Stage: how far the cancer had grown, for example whether it was confined to the kidney or had gone into the surrounding fat or the large vein.
• Grade: how aggressive the cells look under the microscope.
• Type: clear cell cancer is the most common, and papillary, chromophobe and others behave differently.
• Margins: whether the cancer reached the cut edge of the specimen, which is particularly relevant after partial nephrectomy.

A typical schedule

Guidelines differ in detail, and your doctor will set the plan for you. As a general idea:

• Low risk (small, low-grade, confined to the kidney): a scan at about six months to a year, then yearly for around three to five years. Some continue beyond that.
• Intermediate risk: scans every six months for the first two to three years, then yearly until around five years or beyond.
• High risk (large, high-grade, or spread beyond the kidney): scans every three to six months for the first two to three years, then every six months to yearly.

Each visit usually includes a clinical examination, blood tests (kidney function, calcium, liver tests and blood count) and imaging. A CT scan of the abdomen and chest is common. MRI or ultrasound may be used in some people, for instance when kidney function is low or to reduce radiation.

Does everyone get extra treatment after surgery?

Not usually. For most people with a cancer confined to the kidney, surgery alone is the treatment. For selected people at high risk of recurrence, a medicine given after surgery (immunotherapy) has been shown in a clinical trial to reduce recurrence. Whether it is suitable depends on your risk, general health and the availability and cost of treatment. This is a decision to discuss with a medical oncologist.

What if a scan shows something?

Finding something does not always mean the cancer has returned. Scars, cysts and small harmless spots are common. When a change is seen, the next step is usually a closer look: a repeat scan after a short interval, a different type of scan, or sometimes a biopsy. If the cancer has returned, the treatment depends on where it is and how many spots there are. Some single spots can be treated with surgery or focused radiation, and many people are well controlled for a long time. See treatment of advanced kidney cancer for more.

Practical advice

• Keep every report and scan CD or link in one folder, and carry it to every visit.
• Book each scan a week or two before the visit, so the results are ready.
• Tell your doctor early about new back or flank pain, blood in the urine, persistent cough, bone pain, weight loss or a new lump.
• Look after the other kidney: control blood pressure and sugar, avoid regular anti-inflammatory painkillers and do not smoke.

Questions to ask

• What are my stage and grade, and what does that mean for my risk?
• Which scans do I need, how often, and for how long?
• Can some scans be MRI or ultrasound instead of CT, given my kidney function?
• Would any treatment after surgery be advised in my case?

For a full picture of kidney cancer care, see the kidney cancer guide by stage, or ask for a second opinion on your plan.

This article is general information. It does not replace advice from your own doctor, who knows your reports and your health.