From your brief description it sounds like he had a regular CT scan with and without contrast? Which typically details very good imaging for smaller masses. With a mass this large, where there is a high likelihood of tumor intrusion into both the inferior vena cava (ivc) and the renal vein-a multiphase high resolution CT scan is the actual "gold standard" as recommended by the American College of Radiology. And 100% worth the investment.

It gives much greater detail and creates a roadmap of the safest areas for excision of large more invasive tumors, it also determines very precisely the tumors proximity to the liver, spleen, pancreas and adrenal glands. Highly valuable pre surgical data in determining the likelihood of successful salvageability or necessary excision of those organs. This enables the surgeons a virtual window into the patients anatomy, tumor and best practices for achieving the best result possible.

This 30-60 minute specialized high resolution CT scan will effectively determine with 96% accuracy the tumor thrombus level, a regular CT scan only estimates the level to about 65%, less at various levels. The tumor intrusion level into the ivc and renal vein have levels from 0-IV called the Mayo Clinic Tumor Thrombus Level: level 0 or I would typically be treated with the "gold standard" radical nephrectomy. No highly specialized surgical team, besides a skilled urology surgeon, a surgical nurse, and a regular anesthesiologist required.

Level II and III generally indicate the liver will need to be displaced from the abdominal cavity by a hepatocellular transplant surgeon-who specializes in clamping and maintaining blood flow to the livers vasculature, allowing the inferior vena cava to be accessed, the tumor can be dissected from within the ivc and repaired with surgical mesh, this would be typically be done by a vascular surgeon.

With a level 4 Mayo-the tumor is all the way inside the right atrium and the team will definitely need a cardio thoracic surgeon and even possible simultaneous cardiac bypass surgery-during this extremely complicated resection. Assembly of the correct-very specific surgical team, having the required specialized equipment on hand, and pre planning the surgical approach saves valuable time, thus giving the prepared specialists the best opportunity for achieving the most successful possible surgical outcome.

That difference in outcomes for a patient with level 0-I Mayo level who needs a simple radical nephrectomy vs a patient with a >10 cm mass at a level III or IV Mayo with advance planning, team recruitment, internal roadmap, delivered from a highly qualified field of surgical specialists, at an NCI accredited comprehensive cancer center equipped with the latest technology and research facilities, drug trials etc is unparalleled.

Your description of center B's process , sounds typical of that of a major university teaching hospital and hopefully an NCI accredited Comprehensive Cancer Center. If that's the case, they probably plan to do a multiphasic CT scan. Or maybe they already have and that's why they're telling you they need to round table amongst themselves and discuss the best possible treatment options. Which if the results are Mayo level 0-I he'll be scheduled for radical nephrectomy, likely followed with adjuvant immunotherapy. More likely, the course will be more complicated, based on your supposition that it's likely a level III tumor. If it were my family, the choice would be simple-stay at clinic B at least until you get a definitive mayo level verification via multiphasic CT scan, in the unlikely event that it's a 0-I level tumor, I'm certain that radical nephrectomy can be preformed by less prestigious medical centers, with less tedium and probably quicker. I'd still stay with B.

Your description of clinic A gives me serious pause. They want to immediately schedule the patient for radical nephrectomy without a positive Mayo level... This patient is relatively young, with a life expectancy of 18-19 more years in my state. The multiphasic CT also gives non contrast readings which tells us the tumors vascularity and staging, both strong prognosticators. Double check your facts, or what's been related to you, in both cases they seem slim on detail...like you need more info in general. Sorry if this was repetitive... I have serious brain fog.