Denise Szalkowski

Thank you for allowing me to share my story. It is my hope I can highlight the need for early, transparent discussions to support how informed consent and treatment options are communicated to patients.

My journey began on September 18. Following an ultrasound, a solid renal mass was discovered incidentally on my right kidney. As someone who has always prioritized a healthy lifestyle, with routine exercise, I was shocked, confused, and scared.

I took it upon myself to get the best care possible, seeking out multiple opinions with well-regarded surgeons. My mass was small, but I was told that the location made my surgery complicated. One surgeon warned me that based on imaging, he could not rule out an extremely dangerous, locally advanced mass. One surgeon wasn’t confident that a partial nephrectomy was possible, while another stressed that robotic surgery would be extremely dangerous for me. Another surgeon scheduled me for an open partial nephrectomy involving partial rib removal.

The surgeons all had varying opinions on how to approach the mass, which speaks to the complexity of surgery; however, no one suggested that there was an alternative to what they were proposing. They each led me to believe that an open partial nephrectomy was the only way my cancer could be removed safely. None of them discussed long-term consequences associated with an open flank procedure or how something like rib removal might impact my quality of life.

It wasn’t until I connected with Dena Battle at KCCure (The Kidney Cancer Research Alliance) that I was convinced to pursue a fifth opinion. Dr Christopher Weight at Cleveland Clinic was more reassuring about the risks associated with my mass and felt confident that a partial nephrectomy could be done, using a minimally invasive approach. The surgery he suggested offered a shorter recovery time with no rib removal.

This was a critical shift—my initial 4 surgeons didn’t present minimally invasive surgery as an option, while Dr Weight did. This new information allowed me to make a different, informed decision that better suited my needs and recovery goals.

I was fortunate to have a positive outcome, removal of an oncocytic renal neoplasm of low malignant potential. I was discharged from the hospital 24 hours after surgery, and my pain was managed with minimal medication. I recovered quickly and returned to weightlifting and my exercise regimen without compromising my physical strength and mobility.

The fact that multiple surgeons had different opinions on how to treat my renal mass reflects the complexity and variability in medical decisions. Each surgeon brought their unique experience and perspective, but my situation also underscores the need for a more comprehensive and transparent conversation. The decision-making process should have included the risks and benefits of the options presented to me, all available options, including less invasive surgery. Long-term quality of life risks associated with open surgery should have been communicated clearly to me. Health care providers have the responsibility to present all available treatment options, not just the one they are most comfortable with. Patients cannot be expected to meet with 5 surgeons before understanding the full array of treatment approaches available to them.

I hope my story serves as a reminder to health care professionals of the importance of presenting all treatment options early on, especially when the patient’s quality of life and the invasiveness of the surgery are at stake.