Urologist suggests chemo prior to surgery for man with cancer

DEAR DR. ROACH: I am an 82-year old man who was in good health until I found out that I have an issue in my left kidney. My urologist discovered cancer on my urethra, and the cancer was removed in December 2025. This all started when blood was found in my urine back in September 2025. Now I have a mass on my left kidney that was discovered through an MRI.The urologist suggested removing the kidney to prevent cancer from spreading throughout my body. He also suggested doing chemo before the operation rather than after. I'm having tests done to determine if my kidneys are strong enough to handle chemo.Should I take IP6 (inositol hexaphosphate powder) to stop damage from chemo? Also, should I consider consulting with a kidney doctor, or is a urologist well-versed on kidneys? Thank you. -- A.F.ANSWER: I am sorry to hear about these recurrent problems. The MRI can show, with a high degree of certainty, if a kidney mass is actually kidney cancer; however, only a pathological evaluation of the tumor is 100% accurate. Without a precise diagnosis, it is impossible for me to give you personalized recommendations.If your urologist is recommending chemotherapy before surgery, then they must be quite sure that you already have cancer. I'm not sure whether the issue in your kidney now is the same tumor that you had before. (Incidentally, instead of "urethra," I think you mean "ureter," which is the tube that carries urine from the kidney to the bladder. The urethra is the tube that carries urine from the bladder outside of the body, and in men, it goes through the penis.)With some less-common types of cancers, they may recommend chemotherapy before surgery to increase the likelihood of a surgical cure. Chemotherapy is given by oncologists (cancer specialists), and you certainly need to see one.A nephrologist (a medical kidney specialist) would be the ideal person to help with the question of whether your kidneys can handle chemotherapy. But the urologist (the surgical specialist of the kidney, the bladder, and all parts of the urinary system) and the medical oncologist may not need to consult the nephrologist unless the answer isn't clear.There is preliminary evidence that myo-inositol can reduce kidney damage due to some types of chemotherapy, but this is a question for your medical oncologist prior to receiving chemotherapy.DEAR DR. ROACH: Could you address intestinal angina? What are the symptoms, diagnostic tools and treatment? Is there any relation with it to gallbladder issues? I have experienced unexplained nausea after meals for a few months now. -- T.L.ANSWER: Although cardiac angina (a lack of adequate blood supply to the heart) can sometimes cause abdominal symptoms such as pain or nausea, I think you are talking about intestinal (mesenteric or colonic) ischemia. With this condition, there isn't an adequate blood supply to the bowel (either the small or large bowel). Blockages to the blood flow are usually due to extensive atherosclerosis or blood clots (thrombosis or embolism) leading to the blood supply.Pain is the most common symptom of intestinal ischemia, although it can be accompanied by nausea. The pain is usually after eating as this is when the intestines need increased blood flow. If the supply is inadequate due to partial blockages, the pain may be insidious. By contrast, pain from arterial embolism is sudden and severe. I have seen people writhing in bed from the pain of acute mesenteric ischemia (AMI).A CT scan with angiography is the most common way to make the diagnosis. With AMI, the diagnosis is sometimes made during surgery as early surgery can be lifesaving.Most people with mesenteric ischemia have clear risk factors, especially blockages in the heart vessels. Nausea after eating without pain, especially in a younger person who doesn't have risk factors, is not likely to be mesenteric ischemia.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.