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Welcome to the Why Urology podcast with Dr. Todd Brandt.

This podcast is my personal attempt to teach you about your genito-urinary tract, what can go wrong, and how your urologist may just become your superhero.

The name of the podcast comes from my ongoing need to answer the question that I get so often from patients, friends, and family, “Why Urology? Why did you choose to become a urologist?”

Nov 8, 2020

Kidney cancer is most commonly a Renal cell carcinoma (RCC). Renal Cell Carcinoma, with its various subtypes, will be diagnosed in an estimated 73,750 adults (45,520 men and 28,230 women) in the United States this year. Kidney cancer is the sixth most common cancer for men, and it is the eighth most common cancer for women.

A Renal Cell Carcinoma begins in what I call the meaty portion of the kidney, the renal parenchyma. It grows slowly most of the time, forming a mass somewhere in the kidney. If the mass is less than 7 cm and there is no spread to lymph nodes or distant organs it is a stage 1 tumor. If it is larger than 7 cm, but still no spread, it becomes a stage 2 tumor.

Treatment for a Renal Cell Carcinoma, when it is large enough, approaching 2 cm or greater is to either remove or ablate the tumor. If possible, we can remove to tumor from the rest of the kidney leaving a large portion of the kidney intact and functional.

A stage 3 tumor is one of several subtypes.  It can invade into the fat around the kidney, called Gerota’s fascia, or into nearby lymph nodes, or, somewhat unique to kidney cancer, RCC has the ability to locally invade  the veins of the kidney with tumor thrombus that can propagate distally from the segmental renal veins to the main renal vein,  then into inferior vena cava (IVC) and all the way up to the heart into the right atrium. Around 5 % of cases of RCC are reported to have some level of venous invasion, most commonly into the segmental renal veins still within the kidney.

Medicine, they say, is both an art and a science.

The science part slowly removes the veil of mystery about disease. And once the mystery is gone, the art of medicine is at risk of fading in the background. It’s a tug of war, and science is always winning.

Because science is so powerful, there is a constant effort within medical education to make sure we are accepting and training young physicians who are caring, kind, and compassionate to balance the science with the art of medicine. It is a worthy goal.

In this episode I tell you how poetry can help.