Differential diagnosis of advanced right renal cancer

No matter what the disease is, it must be diagnosed clearly before treatment, otherwise it will fall into the misunderstanding of treatment. The same is true for the treatment of kidney cancer. Experts point out that the diagnosis of kidney cancer is mostly not difficult. It can be initially diagnosed based on medical history, pyelography and ultrasound examination. Let's take a look at the differential diagnosis method of late right kidney cancer.

1. Clinical manifestations

The initial diagnosis of kidney cancer is based on clinical manifestations. It is not difficult to diagnose patients with typical symptoms of hematuria, back pain, and masses, but these tumors are often in the late stages. The clinical manifestations of patients are very atypical, and the symptoms are not in the urinary system. In a few patients, the symptoms of metastatic cancer appear earlier than the symptoms of kidney cancer itself, making the diagnosis more difficult.

2. Laboratory Examination

Even if the urine routine test is completely normal, renal cancer cannot be ruled out. Among the 64 cases of renal cancer with relatively complete data in Beijing First Hospital, 28 cases had completely normal urine routine tests. Unless renal cancer has invaded the renal pelvis, urine cytology has little diagnostic value for renal cancer. Because its positive rate is not high. Although the erythrocyte sedimentation rate, urine lactate dehydrogenase, serum alkaline phosphatase, and serum C-protein reaction tests are elevated and positive in most patients with renal cancer, they are non-specific tests and have little diagnostic value for renal cancer.

3. X-ray examination

X-ray examination is a major basis for the initial diagnosis of renal cancer. Most renal cancers are seen as space-occupying lesions on pyelograms, and only a very small number of tumors that are close to the renal capsule and do not cause compression and deformation of the renal pelvis and calyces cannot be shown. Skinner observed that renal cancer is the most common cause of renal space-occupying lesions with hematuria symptoms.

4. Ultrasound examination

This is a non-destructive examination with great diagnostic value. This method is often performed when suspected renal space-occupying lesions are found on the pyelogram. Sometimes it is used as a routine examination method for the kidney. This method can detect whether there are space-occupying lesions in the kidney, and accurately distinguish simple cystic solid tumors based on the height of the echo, whether the echo is attenuated evenly, and whether the inner wall of the lesion is smooth. Hamartomas often have characteristic echoes on the image and are also diagnosed. Uneven echoes indicate tumor necrosis, multilocular cysts, and abscess hematomas, and CT cyst puncture examinations should be performed for further study. This examination can also show whether the tumor has invaded adjacent organs and whether the liver and spleen have metastasized, which is helpful for the staging of the tumor. Its disadvantage is that the image is not as clear as CT, and it cannot clearly show whether the regional lymph nodes and retroperitoneal lymph nodes are enlarged (metastasis).

Diagnostic examination of renal cancer V. Cyst puncture examination

A large dose of contrast medium is used for intravenous pyelography. After the renal pelvis and calyces are developed, a 20-gauge lumbar puncture needle is used to perform cyst puncture under the positioning of the fluorescent screen (CT). This examination includes visual observation of the aspirated fluid, chemical analysis, cytological examination, bacterial culture and cyst X-ray angiography. After a certain amount of fluid is extracted, a certain amount of contrast medium air is injected for cyst angiography to observe whether the inner wall of the cyst is smooth. In patients with cyst infection and concurrent renal cancer necrosis and liquefaction in the cyst, the analysis results of the aspirated fluid show increased protein and lipids. This series of examination results enables the nature of cystic lesions to be accurately diagnosed.

Diagnostic examination of kidney cancer 6. Puncture biopsy is performed with a 22-gauge fine needle under X-ray guidance. Sterile distilled water is injected during the needle withdrawal process and radiotherapy (5Gy) is immediately performed at the puncture site to prevent cancer cell inoculation.

Through the above introduction, you should have a clear understanding of the diagnosis and examination of kidney cancer. As long as you notice abnormalities in the kidneys, even if there are no symptoms of kidney disease, do not ignore it, and treat it symptomatically as soon as possible. Some people do not go through the chronic process and quickly develop into renal failure or even kidney cancer.