15. Mr B complains about the Trust’s decision to discharge his mother from its urology services on 1 April 2018. He says his mother had a tumour on her right kidney and the Trust discharged her without any further monitoring of her condition.
16. The Trust say Mrs C was referred to its services on 16 July 2013. She had a 26mm tumour in her right kidney. She had scans on an annual basis between 2013 and 2018. The scans showed no changes. In 2016 and 2017 the CT scans confirmed the stable appearance of the tumour. In 2018 the CT scan showed the tumour had remained unchanged in the last five years. The consultant urologist felt it was unlikely to progress and recommended it stop further regular scans and Mrs C was discharged.
17. The records show at the time of her referral to the Trust in 2013, Mrs C was 69 years old. She had a history of chronic kidney disease, high blood pressure, rheumatic mitral valve disease, mechanical aortic valve for which she was on life long anti-coagulant therapy.
18. In July 2013 a CT scan showed Mrs C had a tumour on her right kidney. She was referred to the urology department at the Trust.
19. On 8 August 2013 Mrs C’s case was discussed at a multi-disciplinary team (MDT) meeting. She had a 26mm tumour in her right kidney. A CT scan including of her thorax was recommended in six months. On 3 February 2014 Mrs C attended her appointment and her CT scan was reviewed. It showed there was no change to her 26mm tumour. A repeat CT scan was recommended in a year.
20. On 16 February 2015 Mrs C attended the Trust and her recent CT scan on 19 January 2015 was reviewed. The tumour remained static and in view of her comorbidities the Trust said it would be reasonable to continue with surveillance.
21. On 15 February 2016 Mrs C’s scan was reviewed. The CT scan showed no changes. A repeat scan was recommended in one year.
22. On 20 February 2017 a further CT showed no obvious changed. The plan was to review Mrs C in one year.
23. The Trust explains on 24 April 2018 Mrs C had a further CT scan. On 30 April 2018 she was reviewed. The consultant urologist explained the tumour remained unchanged over the last five years. The radiologist said as the tumour had remained unchanged for five years the enhancement of the tumour was not very high. The consultant urologist felt the tumour was unlikely to progress and recommended they stop further surveillance was regular scans.
24. The Trust explains on 7 December 2022 a gastroenterologist did a CT scan which showed a large right renal tumour which had spread. On 16 January 2023 the consultant urologist explained the findings to Mrs C and arranged a biopsy with a view to offering treatment. The biopsy of the renal tumour confirmed collecting duct renal cell carcinoma.
25. We have seen due to Mrs C significant co-morbidities and the small size of her tumour she was being managed with active surveillance. This is in line with section 7.1.4.2 of EAU guidelines for surveillance which says active surveillance is appropriate for initially monitoring small renal masses.
26. Our adviser confirms at the time there would have been no official guidance to say when a patient should be discharged from active surveillance. Current NICE guidance which is due for publication in March 2026 says to considers discharging a patient from active surveillance if lesions remained stable or with minimal changes for five years or more. While we are not holding the Trust to this guidance as it was not in place at the time of Mrs C treatment, we are satisfied this represents best practice at that time.
27. Our adviser says at the time in 2018 and currently it would have been appropriate for the Trust to discuss stopping active surveillance for Mrs C as she was 75 years old and had significant co-morbidities and her tumour had remained stable for five years. Ultimately it should be a shared decision making process with the patient. We can see in the Trust’s response letter the consultant had the patient’s approval to stop further surveillance.
28. There is no indication the Trust should have done anything differently. The only way this rare form of kidney cancer could have been diagnosed early would have been if a patient had surgery or a biopsy of the kidney tumour. Our adviser says both of these options given Mrs C’s comorbidities would have been high risk as she would have had to stop her anticoagulant treatment which she required for her heart. Our adviser says given Mrs C’s tumour had been stable for five years neither surgery or a biopsy would have been indicated. We hope this provides the family with reassurance.
29. We understand how distressing it was for the family when they were told in January 2023 Mrs C had renal cancer. When we weigh up the available evidence, we can see the Trust monitored Mrs C on an annual basis for any changes to her tumour. Her tumour remained stable for five years and the Trust acted in accordance with best practice at the time by stopping active surveillance. We consider the care provision appropriate.
30. This ends our report.