Kidney Cancer Found Late: Incidental Renal Masses in Oregon

A patient goes in for a CT scan for one reason, perhaps abdominal pain or a check after a car crash. The radiologist reads the images and notes something unrelated in the report: a mass on one kidney, with a recommendation for more imaging. The original problem is treated. The kidney finding is never mentioned again. Years later the patient is diagnosed with kidney cancer, and the old report turns up in the chart.

A finding like this is called an incidental finding. It is something seen on a scan that was ordered for a different purpose. This article explains what federal health agencies and the American College of Radiology say about incidental kidney masses, and how Oregon law frames a delay in following one up. It does not assess any particular case.

Related pages cover radiology misreads and abnormal test results that never reached the patient. This article covers a narrower path: the finding was seen and written down, but it fell outside the reason for the scan.

Why kidney masses turn up on scans ordered for something else

Kidney cancer can be quiet early on. The National Cancer Institute (NCI) lists blood in the urine and a lump in the abdomen as signs of renal cell cancer, but adds: "There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows."¹ Renal cell cancer is, according to NCI, "the most common type of kidney cancer in adults."¹

Not every kidney spot is cancer. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says simple kidney cysts "are usually harmless." It also explains that because they "usually don’t cause symptoms," health care professionals "often find simple kidney cysts when they are performing an imaging test for another reason."² NIDDK adds that health care professionals "may use imaging tests and lab tests to rule out other, more serious problems, including some kidney cancers."²

So a scan can show that something is there without settling what it is. Telling a harmless cyst apart from a mass that needs attention can take another step, such as more imaging or lab tests.²

What radiology guidance says about an incidental kidney mass

The American College of Radiology (ACR) has an Incidental Findings Committee, and one of its white papers addresses "renal masses that are incidentally detected on CT." According to its summary, each flowchart in the paper "describes imaging features that identify when there is a need for additional imaging, surveillance, or referral for management." The summary also says the recommendations "draw from published evidence and expert opinion and were finalized by informal iterative consensus."³ In other words, the paper is a set of expert recommendations about which incidental kidney masses call for a next step. It is not a statute.

Why the timing matters in kidney cancer

Cancer stage, as NCI explains, describes the extent of cancer in the body, including whether and how far it has spread. Under the staging NCI describes, in stage I "the tumor is 7 centimeters or smaller and is found in the kidney only." In stage IV, the cancer has spread beyond the fatty tissue around the kidney, or to other parts of the body "such as the bones, liver, lungs, brain, adrenal glands, or distant lymph nodes."¹

NCI states that "[c]urrent treatment cures more than 50% of patients with stage I renal cell cancer, but patients with stage IV disease have poor outcomes."⁴ National cancer statistics show the same gap. For kidney and renal pelvis cancer in the 2016–2022 period, NCI's SEER program reports five-year relative survival of 93.6% when the cancer is localized, 77.6% when it has spread to regional lymph nodes, and 20.3% when it has spread to distant sites.⁵ These population figures do not predict any one person's outcome. NCI notes that prognosis and treatment options depend on the stage of the disease and on the patient's age and general health.¹ Whether a particular delay changed a particular patient's stage is a separate question, and it depends on the medical facts.

For more on how harm from a delay is proved, see proving damages in a delayed cancer diagnosis.

Who is responsible for following up an incidental finding?

An incidental finding raises a question that an ordinary result does not. The doctor who ordered the scan was looking for something else. The radiologist who found the kidney mass may not be the doctor managing the patient's care. So who carries the finding forward?

The ACR's practice parameter on communicating imaging findings addresses both sides. In its list of what a report's impression should contain, it states: "Follow-up or additional diagnostic studies to clarify or confirm the impression should be suggested when appropriate."⁶ It describes "a reciprocal duty of information exchange," and states: "The referring physician or other relevant health care provider also shares in the responsibility for obtaining results of imaging studies ordered and acting on them in an appropriate manner."⁶

The same document lists situations that may call for faster, nonroutine communication. One is "[f]indings that the interpreting physician reasonably believes are significant and unexpected, may have a reasonable probability of impacting the patient’s health, and may not require immediate attention but, if not acted on, may worsen over time and likely result in an adverse patient outcome."⁶ It says interpreting physicians "should document all nonroutine communications."⁶

The ACR also limits how its guidance may be used. It says practice parameters "are not intended, nor should they be used, to establish a legal standard of care," and that "an approach that differs from the guidance in this document, standing alone, does not necessarily imply that the approach was below the standard of care."⁶ So the guidance shows how the profession describes shared responsibility. It does not decide a legal question by itself.

Questions that can arise in an incidental-finding case include these. What did the report say and recommend? Who received it? Was the kidney finding passed on when the patient moved from an emergency room or specialist back to a primary care doctor? Was any follow-up ordered or offered?

Oregon's standard of care

Oregon measures a physician's conduct under ORS 677.095(1). A physician licensed to practice medicine or podiatry by the Oregon Medical Board "has the duty to use that degree of care, skill and diligence that is used by ordinarily careful physicians in the same or similar circumstances in the community of the physician or a similar community."⁷ Subsection (2) sets a parallel duty for physician associates.⁷

That duty applies to each physician licensed by the Oregon Medical Board who took part in the patient's care. For an incidental kidney mass, that can mean asking separately what an ordinarily careful radiologist would have put in the report, and what an ordinarily careful ordering or treating physician would have done after receiving it.

The deadlines

Oregon's medical-malpractice limitations period is in ORS 12.110(4). An action "shall be commenced within two years from the date when the injury is first discovered or in the exercise of reasonable care should have been discovered."⁸ The Oregon Supreme Court explained in Gaston v. Parsons, 318 Or 247 (1994), that the period begins "when the plaintiff knows or in the exercise of reasonable care should have known facts which would make a reasonable person aware of a substantial possibility that each of the three elements (harm, causation, and tortious conduct) exists."⁹ The court added that "a mere suspicion is insufficient to begin the statute of limitations to run."⁹

There is also an outer limit. The same subsection continues: "However, notwithstanding the provisions of ORS 12.160, every such action shall be commenced within five years from the date of the treatment, omission or operation upon which the action is based …"⁸ If no action was started within five years because of fraud, deceit or misleading representation, the subsection allows two years from when that conduct is discovered or reasonably should have been discovered.⁸

If the cancer proves fatal, the claim moves under ORS 30.020(1). The action must be commenced within three years after the injury causing the death is discovered or reasonably should have been discovered, and "[i]n no case may an action be commenced later than the earliest of: (a) Three years after the death of the decedent; or (b) The longest of any other period for commencing an action under a statute of ultimate repose that applies to the act or omission causing the injury, including but not limited to the statutes of ultimate repose provided for in ORS 12.110 (4) …"¹⁰ Because the ORS 12.110(4) repose runs from the treatment or omission rather than from the death, the outer deadline in a kidney-cancer death case can fall earlier than three years after the death.⁸

Kidney cancer can also show itself through blood in the urine.¹ A related page covers hematuria that is not investigated.

This article is educational

This article describes Oregon law in general terms. It is not legal advice and does not create an attorney-client relationship.

Time limits matter. Most Oregon personal-injury and auto-accident claims must be filed within two years of the injury or accident. Medical malpractice claims must be filed within two years of when you knew or reasonably should have known of the negligence, with an outer limit of five years from the act itself (with a fraud exception). Wrongful death claims must be filed within three years of the date of death. Claims against public bodies (cities, counties, state agencies, public hospitals) require a notice of claim within 180 days. Missing these deadlines typically ends a case.

If you think you may have a claim, call Huegli Law at 971-317-6436 for a free case review. Todd Huegli is licensed in Oregon and consults on cases in Oregon only.

Footnotes

1. Renal Cell Cancer Treatment (PDQ®)–Patient Version. National Cancer Institute. https://www.cancer.gov/types/kidney/patient/kidney-treatment-pdq ↩ ↩² ↩³ ↩⁴ ↩⁵

2. Simple Kidney Cysts. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/kidney-disease/simple-kidney-cysts ↩ ↩² ↩³

3. Herts BR, et al. Management of the Incidental Renal Mass on CT: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2018;15(2):264-273 (PubMed abstract). https://pubmed.ncbi.nlm.nih.gov/28651987/ ↩

4. Renal Cell Cancer Treatment (PDQ®)–Health Professional Version. National Cancer Institute. https://www.cancer.gov/types/kidney/hp/kidney-treatment-pdq ↩

5. Cancer Stat Facts: Kidney and Renal Pelvis Cancer. National Cancer Institute, SEER Program. https://seer.cancer.gov/statfacts/html/kidrp.html ↩

6. ACR Practice Parameter for Communication of Diagnostic Imaging Findings (Revised 2025). American College of Radiology. https://gravitas.acr.org/PPTS/DownloadPreviewDocument?DocId=74 ↩ ↩² ↩³ ↩⁴ ↩⁵

7. ORS 677.095 — Duty of care. Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ors677.html ↩ ↩²

8. ORS 12.110 — Actions for certain injuries to person not arising on contract. Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ors012.html ↩ ↩² ↩³ ↩⁴

9. Gaston v. Parsons, 318 Or 247, 864 P2d 1319 (1994). Caselaw Access Project. https://static.case.law/or/318/cases/0247-01.json ↩ ↩²

10. ORS 30.020 — Action for wrongful death. Oregon State Legislature. https://www.oregonlegislature.gov/bills_laws/ors/ors030.html ↩