NEWARK, NJ - Kidney cancer accounts for about three percent of all malignancies and often remains undetected until the advanced stage. Such was the case of Kelly Tobin, 46 of Sea Bright, who was shocked that the assortment of symptoms she considered signs of aging, were caused by a single tumor that wrapped around her kidney and slinked through a major blood vessel all the way into her heart. Last month, in a rare case of locally advanced kidney cancer, a team of 11 physicians operated for nine and half hours to remove a mammoth tumor from her chest and abdomen.
“I’ve seen a handful of these tumors in my career, but never one this large,” said Ravidra Karanam, MD, cardiothoracic surgeon at the Saint Barnabas Heart Center at Newark Beth Israel Medical Center. Dr. Karanam removed a lemon-sized portion of the tumor that spread to Ms. Tobin’s heart and had completely obstructed her superior vena cava, the major vein that returns blood from the lower half of the body to the heart. He also repaired a condition know as patent foramen ovale, a small hole between the upper chambers of the heart that fails to close naturally after birth.
“I had some shortness of breath but I thought it was because I was out of shape,” remembered Ms. Tobin. She considered the extra weight around her waist a product of middle age and doctors told her that other symptoms she had been experiencing for several months were consistent with perimenopause. Because her career as a hair stylist keeps her on her feet, Ms. Tobin didn’t consider the swelling in her legs unusual either.
The mass had a tremendous blood supply and its surface was covered with many blood clots that could break away and cause a stroke at any moment. To help reduce the risk of hemorrhage, 24 hours before the surgery Ms. Tobin underwent a catheter procedure that cut off blood flow to the football-sized portion of the tumor that engulfed the affected kidney.
“Typically we take these tumors out in one piece, but because of its extraordinary size, we operated in her chest and abdomen at the same time.” said Bruce Brener, MD, Director of the Vascular Center of Saint Barnabas Health Care System. Surgeons also repaired her common bile duct that was invaded by the tumor.
“What made Ms. Tobin’s case so challenging was the need for highly expert and coordinated care,” said Indu Sabnani, MD, oncologist. Doctors specializing in cardiology, urology, oncology, general surgery and interventional radiology worked together with the nursing team to bring Ms. Tobin through the complex surgery.
“I feel better than I have in a very long time,” said Ms. Tobin. “I have four important things going for meamazing doctors, divine intervention, positive thinking and supportive friends and family.”
“In an era of targeted therapy for renal cell carcinoma, I am very optimistic for Ms. Tobin,” said Dr. Sabnani.
Physician Team Leaders
Trevor Atherley, MD, Cardiology
Kamalakar Ayyagari, MD, General Surgery
Bruce Brener, MD, Vascular Surgery
Chunguan Chen, MD, Cardiac Imaging
Ravindra Karanam, MD, Cardiothoracic Surgery
Luke Lin, MD, Anesthesiology
Prakash Paragi, MD, General Surgery
Indu Sabnani, MD, Oncology
Suken Shah, MD, Interventional Radiology
Alan Strumeyer, MD, Urology
Cindy Sturt, MD, Vascular Surgery