Kidney cancer

Introduction to kidney cancer Renal cell carcinoma, also known as renal cell carcinoma, is the most common malignant tumor of the kidney. Due to the prolonged life expectancy and advances in medical imaging, the incidence of kidney cancer is higher than before, and there are no clinical symptoms. The number of kidney cancers that were accidentally discovered increased day by day, reaching 1/2 to 1/5. Kidney cancer occurred mostly in 50 to 70 years old, and men were more than twice as likely as women. The cause of kidney cancer is still unclear, and statistics indicate that it may be related to smoking, especially in male patients. In addition, kidney cancer has a family phenomenon, suggesting that genetic factors may be involved. basic knowledge The proportion of illness: 0.0003% Susceptible population: kidney cancer occurs mostly in 50 to 70 years old, and males have a higher incidence than females. Mode of infection: non-infectious Complications: hematuria anemia hypertension

Cause of kidney cancer

Cause:

The etiology of kidney tumors is still unclear. Ethnic groups and geographical conditions are not important factors in causing kidney tumors. It has been reported that aromatic hydrocarbons, aromatic amines, aflatoxins, hormones, radiation and viruses can cause kidney cancer; some inheritance Sexual diseases such as tuberous sclerosis, multiple neurofibromatosis, etc. may be associated with renal cell carcinoma, renal combination with renal pelvic cancer, may be associated with local chronic chronic irritation. Some scholars proposed the relationship between smoking and kidney cancer in 1990. The risk of kidney cancer was twice as high as that of non-smokers. The incidence of heavy smokers was higher than that of mild smokers. The length of smoking and the prevalence of smoking. Directly related, and believe that the content of various mutagenic active substances in the urine of smokers is increased; dimethylnitrosamine in tobacco causes kidney cancer, although it has not been clinically confirmed, but rabbits have induced kidney cancer in animal experiments. Therefore, they believe that smoking habits combined with other risk factors such as alcoholism, occupational exposure, etc., can further increase the risk of developing kidney cancer.

Kidney cancer prevention

First, do a good daily diet conditioning

In our daily life, in addition to ensuring nutrition, protein, vitamins, etc. should be properly matched, and also have some purpose to eat some anti-cancer substances, such as mushrooms, garlic and so on. This is to be noted in the prevention of kidney cancer. This is also a preventive measure for kidney cancer.

Second, fasting and degrading food

The so-called disease from the mouth, some moldy food must not be eaten, and daily eat less pickled foods, such as pickles, sauerkraut, cured meat and so on. Prevention of these kidney cancers is important.

Third, active early treatment

Active treatment is for other diseases of the kidney, such as kidney cysts. If these diseases are not treated in time, it is easy to develop dysplastic lesions and induce kidney cancer. Long-term clinical studies have also shown that people with kidney disease have a higher risk of illness than normal people. This is also a preventive method for kidney cancer.

The above mentioned content is the prevention of kidney cancer, I hope everyone can understand. As long as you know the prevention methods of these kidney cancers, you can let people do the defense against this disease, and then they will greatly reduce their incidence. Therefore, if you want to stay away from the interference of this disease, please learn more about the prevention of kidney cancer. I wish all patients can fight the disease in the end.

Kidney cancer complications Complications, hematuria, hypertension

In addition to the three typical symptoms of hematuria, low back pain and lumps, there are many non-urinary extrarenal manifestations of non-urinary system such as high fever, abnormal liver function, anemia, hypertension, polycythemia and hypercalcemia.

Kidney cancer symptoms Common symptoms Lower abdomen mass weight loss Lower abdomen dull pain and soreness Low back pain with kidney area slap pain Lower abdomen tenderness Loss of appetite

The main complaints and clinical manifestations of patients with renal cancer are changeable, and it is easy to be misdiagnosed as other diseases. The kidney position is concealed. The main connection with the outside world is urine. Therefore, hematuria is the most common condition for finding kidney cancer, but the appearance of hematuria must be invaded by the tumor invading the renal pelvis. It is possible, therefore, not an early condition. For many years, hematuria, pain and lumps have been called the "triple syndrome" of kidney cancer. Most patients have one to two symptoms at the time of treatment, and the triads account for about 10%. It is very unlikely that it will be cured.

1. Hematuria: hematuria is often painless intermittent episodes of the whole eye visible hematuria, intermittent period with the development of lesions shortened, kidney cancer bleeding may be accompanied by renal colic, often caused by blood clots through the ureter, renal cancer hematuria blood clot may pass The ureter forms a strip, and the degree of hematuria is not related to the size of the kidney cancer. Kidney cancer can sometimes be characterized by persistent microscopic hematuria.

2. Low back pain: Low back pain is another common symptom of kidney cancer. Most of them are dull pain, limited to the waist. Pain is often caused by swelling of the kidney and the kidney capsule is caused by the growth of the blood. The blood clot can also cause low back pain through the ureter. The tumor invades the surrounding organs. Pain and heavier muscles are more severe and persistent.

3. Lump: The mass is also a common symptom. About 1/3 to 1/4 of patients with kidney cancer can find a swollen kidney at the time of treatment. The kidney is in a hidden position. The kidney is difficult to find before reaching a considerable volume. Touching the lump is a late symptom.

4. Pain: Pain is found in about 50% of cases, and is also a late symptom. It is caused by a tumor that is gradually growing up in the renal capsule or renal pelvis, or because of tumor invasion, compression of the connective tissue of the posterior abdomen, muscle, lumbar or lumbar nerve. Caused by the affected side of the waist sustained pain.

5. Other symptoms: fever of unknown cause, or metastasis when just found, fatigue, weight loss, loss of appetite, anemia, cough and hemoptysis, etc. In addition, the role of renal adenocarcinoma is caused by tumor endocrine activity. Caused by, including polycythemia, hypertension, hypotension, hypercalcemia, fever syndrome, although these systemic, toxic and endocrine effects are non-specific, about 30% of patients first have a lot of mixed Performance, and thus a valuable clue, is considered a systemic effect of the tumor.

Kidney cancer examination

l. General examination: hematuria is an important symptom, polycythemia occurs mostly in 3% to 4%; progressive anemia can also occur, bilateral renal tumors, total renal function usually does not change, erythrocyte sedimentation rate increases, some patients with renal cancer There is no bone metastasis, but there may be symptoms of high blood calcium and increased serum calcium levels. The symptoms of kidney cancer are quickly relieved after resection, and the blood calcium is returned to normal. Sometimes it can progress to liver dysfunction, such as resection of tumor nephropathy. normal.

2. X-ray angiography is the main means of diagnosing kidney cancer

(1) X-ray film: X-ray film can see the shape of the kidney is enlarged, the contour is changed, occasional tumor calcification, limited or extensive flocculation in the tumor, can also become a calcification line around the tumor, shell Shape, especially in young people with kidney cancer,

(2) intravenous urography, intravenous urography is a routine examination method, because it can not show tumors that have not caused kidney and kidney pelvis undeformed, and it is difficult to distinguish whether the tumor is kidney cancer, renal angiomyolipoma, renal cyst, so its The importance of decline, must be simultaneously identified by ultrasound or CT examination, but intravenous urography can understand the function of bilateral kidneys and the ureter and ureter and ureter and bladder, which has important reference value for diagnosis.

(3) renal angiography: renal angiography can be found in urinary tract angiography undeformed tumors, renal cancer showed neovascularization, arteriovenous fistula, contrast agent pool-like aggregation (Pooling) envelope vascular increase, angiographic variation, sometimes Kidney cancer may not be developed, such as tumor necrosis, cystic changes, arterial embolism, etc. Renal artery angiography may inject normal adrenaline into the renal artery and normal vasoconstriction without tumor vasculature. In larger renal cancer, selective renal artery Renal artery embolization can also be performed during angiography, which can reduce the possibility of surgical resection of hemorrhagic renal cell carcinoma and severe renal hemorrhage.

3. Ultrasound scan :

Ultrasonography is the easiest and most non-invasive method to examine. It can be used as part of a routine physical examination. Ultrasound scans of more than 1 cm in the kidney can be found by ultrasound scan. It is important to identify whether the tumor is a kidney cancer or a solid tumor due to its There may be bleeding, necrosis, cystic changes inside, so the echo is not uniform, generally low echo, the state of kidney cancer is not clear, this is different from renal cysts, renal space occupying lesions may cause renal pelvis, renal pelvis, Renal sinus fat deformation or rupture, renal papillary cystadenocarcinoma is similar to cysts, and may have calcification. Kidney cancer and cysts can be puncture when it is difficult to identify. Puncture under ultrasound guidance is safe. Puncture can be used for cytological examination. Parallel cyst angiography, cyst fluid is often clear, no tumor cells, low fat, smooth wall when angiography can be definitely benign lesions, such as puncture fluid for bloody tumors, tumor cells may be found in the extract, sac wall It can be diagnosed as a malignant tumor without being smooth, and the renal angiomyolipoma is a solid tumor of the kidney. The ultrasound is characterized by a strong echo of the adipose tissue. Different from kidney cancer, when kidney cancer is found by ultrasonography, attention should also be paid to whether the tumor penetrates the capsule, perirenal adipose tissue, with or without enlarged lymph nodes, renal vein, no tumor thrombus in the inferior vena cava, and whether the liver has Transfer and so on.

4. CT scan:

CT plays an important role in the diagnosis of renal cell carcinoma. It can be found in renal cell carcinoma without renal pelvis and renal pelvis. It can accurately measure tumor density and can be performed in outpatient clinics. CT can be accurately staged. Some people have statistically diagnosed the diagnosis accuracy: Invasion of the renal vein 91%, the spread of the kidney around 78%, lymph node metastasis 87%, 96% of the nearby organs, kidney cancer CT examination showed a renal parenchyma mass, can also be prominent in the renal parenchyma, the mass is round, round Or lobulated, the boundary is clear or fuzzy, the soft tissue block with uneven density during the plain scan, CT value>20Hu, often between 30~50Hu, slightly higher than the normal renal parenchyma, but also similar or slightly lower, the internal is not Uniform hemorrhage, necrosis or calcification, sometimes manifested as cystic CT value but soft tissue nodules in the cyst wall. After intravenous injection of contrast agent, the CT value of normal renal parenchyma is about 120Hu, and the CT value of the tumor is also increased, but obviously Lower than the normal renal parenchyma, the tumor boundary is more clear, such as the CT value of the tumor does not change after the enhancement, may be a cyst, combined with the CT value before and after the injection of contrast agent can determine the diagnosis, necrosis in the kidney cancer, kidney Cyst gland After renal artery embolization, the CT value does not increase after the injection of contrast agent. Renal angiomyolipoma is often negative because of its large amount of fat, and the internal value is not uniform. The enhanced CT value is increased, but it still appears as The fat density, eosinophilic tumor edge was clear at the time of CT examination, the internal density was uniform, and the CT value was significantly increased after enhancement.

CT examination to determine the extent of renal cancer invasion

(1) The mass is confined to the renal capsule: the shape of the kidney is normal or limited, or evenly enlarged, and the protruding surface is smooth or slightly rough. If the mass is nodular, it protrudes into the renal capsule, and the surface is still considered to be limited. In the renal capsule, the fat sac is clear, and the perirenal fascia is not irregularly thickened. It is impossible to judge whether the tumor is confined in the renal fascia, especially in patients with wasting.

(2) localized in the peri-renal invasion of the fat sac: the tumor protrudes and replaces the local normal renal parenchyma, the renal surface is rough, the renal fascia is irregularly thickened, and the soft sac has soft-structured nodules with borders, linear soft tissue Shadow is not diagnosed.

(3) Intravenous invasion: the renal vein is thickened into a local fusiform bulging, the density is uneven, abnormally increased or decreased, the density changes the same as the tumor tissue, the standard of the vein thickening, the diameter of the renal vein is >0.5cm, under the upper abdomen The diameter of the vena cava is >2.7 cm.

(4) Invasion of lymph nodes: renal pedicle, abdominal aorta, inferior vena cava and circular soft tissue shadows between them, the density change after enhancement is not significant, can be considered as lymph nodes, <1cm is not diagnosed, lcm is considered as metastatic cancer.

(5) Invasion of adjacent organs: the boundary between the mass and the adjacent organs disappears and the morphology and density of adjacent organs change. If it is simply expressed as the disappearance of the fat line between the tumor and the adjacent organs, no diagnosis is made.

(6) Infiltration of renal pelvis: The edge of the tumor into the renal pelvis is smooth and round, and the arc is compressed in half a month. The delayed scanning shows that the edge of the contrast agent in the compressed renal pelvis is smooth and tidy, which is considered to be pyelonephritis. simple compression, such as renal pelvis and renal pelvis structure disappeared or occluded and all occupied by the tumor, suggesting that the tumor has worn through the renal pelvis.

5. Magnetic resonance imaging (MRI):

Magnetic resonance imaging examination of the kidney is ideal. The renal and perirenal interstitial fat produces high signal intensity, the renal outer cortex is high signal intensity, and the middle medulla is low signal intensity, possibly due to different osmotic pressure in the renal tissue. Part of the contrast difference is 50%, this difference can be reduced with the recovery time and hydration, the renal artery and vein have no intracavitary signal, so the low intensity, the collection system has low urine intensity, and the MRI variation of renal cancer is large. Tumor blood vessels, size, presence or absence of necrosis, MRI can not find calcification well, because of its low proton density, MRI on the scope of renal cancer invasion, surrounding tissue capsule, liver, mesentery, psoas muscle changes are easy to find, In particular, renal cancer has renal vein, inferior vena cava tumor thrombus and lymph node metastasis.

Diagnosis and identification of renal cancer

diagnosis

Diagnosis based on symptoms and examinations. Hematuria is an important symptom, polycythemia usually occurs in 3% to 4%; progressive anemia can also occur, bilateral renal tumors, total renal function usually does not change, erythrocyte sedimentation rate increases, some kidney cancer patients have no bone metastasis, However, there may be symptoms of hypercalcemia and increased serum calcium levels. Symptoms of renal cancer are quickly relieved after resection, and blood calcium is returned to normal. Sometimes liver dysfunction can be developed. If the tumor is resected, it can return to normal.

Differential diagnosis

Because kidney cancer has a variety of imaging methods, there is no difficulty in preoperative diagnosis, but the situation of misdiagnosis and mistreatment still occurs from time to time, sometimes causing irreparable errors, so it must be noted.

1. Kidney cyst:

Typical renal cysts are easily differentiated from renal cancer from imaging examinations. However, when there is bleeding or infection in the cyst, it is often misdiagnosed as a tumor, and some renal clear cell carcinomas are even inside, showing a weak hypoechoic. It is easy to be misdiagnosed as a very common renal cyst during physical examination screening. Cloix reported 32 cases of complex cystic space of the kidney and found that 41 of them were kidney cancer, irregular thickening of the wall and high density of the center. Benign renal cysts, which are difficult to use by any of the above-mentioned methods of examination, are often difficult to analyze. Judging, if necessary, B-ultrasound guided biopsy, easy to abandon follow-up or reckless surgery is not possible Take it.

2. Renal hamartoma:

Also known as renal angiomyolipoma, is a relatively common benign tumor of the kidney. With the widespread development of imaging examinations, it is more and more common in clinical practice. In typical hamartomas, due to the presence of fat components, in B-ultrasound Qualitative diagnosis can be made on both CT and MRI images. It is easy to distinguish from renal cell carcinoma in clinical practice. B-ultrasound of renal hamartoma has a medium-strong echogenic area, and CT shows a region with a negative CT value in the mass. After scanning, it was still negative. Angiography showed that the tumor blood vessels contracted with the blood vessels of the kidneys after injection of epinephrine. The B-ultrasound of renal cell carcinoma showed low and medium echoes. The CT value of the tumor was lower than that of normal renal parenchyma. Increased, but not as good as normal kidney tissue, angiography showed that the kidney itself vasoconstricted after injection of adrenaline, but the tumor blood vessels did not shrink, and the tumor vascular characteristics were more obvious.

It can be seen that the distinguishing point between renal cancer and renal hamartoma is that there is no adipose tissue in the renal cancer and adipose tissue in the hamartoma, but in a few cases, the renal cell carcinoma tissue also contains adipose tissue, which causes misdiagnosis. In addition, it is not uncommon for a hamartoma with few fat components to be misdiagnosed as renal cancer. Of the 49 patients with hamartoma admitted to our hospital from 1984 to 1996, 11 were hypoechoic due to preoperative B-mode ultrasound and/or CT is diagnosed as renal cancer for medium-high-density masses. The causes of misdiagnosis are: some hamartomas are mainly composed of smooth muscle, and there are few fat components; intratumoral hemorrhage, covering up fat components, causing B-ultrasound and CT to be indistinguishable; The volume is small, due to the volume effect, CT is difficult to measure the true density of the tumor. In this case, adding a thin layer of CT scan, if necessary, B-ultrasound guided needle cytology can be helpful for diagnosis, and some authors believe that The CT features of hamartomabial hemorrhage masking adipose tissue are significant, but the interference with B-ultrasound results is less.

3. Renal lymphoma:

Renal lymphoma is rare but not uncommon. Dimopoulos et al reported that 6 of 210 patients with renal tumors had primary renal lymphoma, which was characterized by imaging defects and multiple nodular or diffuse Wet the kidneys, increase the shape of the kidneys, and suffer from more retroperitoneal lymph nodes. Of the 4 patients admitted to our hospital in recent years, 3 were not diagnosed before surgery, and 1 patient was confirmed by preoperative biopsy.

4. Kidney yellow granuloma:

It is a rare type of severe chronic renal parenchymal infection. There are two manifestations in morphology: one is diffuse, the kidney is enlarged, the shape is abnormal, the internal structure is disordered, and it is not easy to be confused with the tumor; the other is Focal, the kidney has a localized substantial nodular echo, lack of specificity, and sometimes difficult to identify with the tumor, but this part of the patient generally has symptoms of infection, the kidney area can reach the tender mass, there are a large number of urine White blood cells or pus cells, as long as careful observation, differential diagnosis is not difficult.

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