What are the treatment and diagnosis methods for kidney cancer?

The natural history of renal cancer provides us with a basis for evaluating patients and staging. When evaluating a patient with hematuria, back pain, or a mass in the waist or abdomen, we should ask whether there are systemic symptoms such as weight loss, fever, and discomfort. Let's focus on this issue and let the experts introduce it to you.

The basic treatment for renal cancer is radical nephrectomy. Early renal cancer is mainly treated with surgery. Renal cancer is not sensitive to radiotherapy and chemotherapy. These methods are generally not used as routine adjuvant treatments. Immunotherapy such as IL-2 and INF-α can be used as postoperative preventive treatment for renal cancer. Biological treatment is mainly used for advanced and metastatic renal cancer, and its efficacy is limited and needs to be improved. Targeted therapy is mainly used as an adjuvant treatment for metastatic renal clear cell carcinoma.

The prognosis of renal cancer is closely related to the tumor stage. The 3-year survival rate of patients with renal cancer who cannot undergo surgical resection is less than 5%, and the 5-year survival rate is less than 2%. The 5-year survival rate after radical surgery is: 60%-90% for early localized intrarenal tumors; 40%-80% for those without invading the perirenal fascia; and only 2%-20% for tumors that extend beyond the perirenal fascia. Occasionally, metastatic lesions spontaneously regress after resection of primary renal tumors.

From the perspective of the cause, treatment and prognosis of kidney cancer, when the cause of the tumor is not fully understood, tumor prevention, that is, preventing tumors from growing in the body, is a relatively difficult task for individual patients. Therefore, early detection, early diagnosis and early treatment become the most reliable and feasible methods for kidney cancer patients to obtain the best results.

Macroscopic hematuria with streaks of blood clots indicates that bleeding occurs in the upper urinary tract. During physical examination, attention should be paid to the presence of hypertension and supraclavicular lymphadenopathy. Lumbar or abdominal masses may be accompanied by murmurs. The right varicocele that does not disappear when lying flat indicates the possibility of vena cava tumor thrombosis. Standard laboratory tests should include complete blood cell count, coagulation function test and serum biochemistry test. Bone scan should be performed when serum alkaline phosphatase is elevated or there are symptoms of bone pain.

Preoperative diagnosis of renal cancer depends on the results of imaging examinations, which can provide the most direct basis for diagnosis. At the same time, imaging diagnostic technology can also make accurate tumor staging in most cases, which is crucial for the choice of subsequent treatment methods. Usually, imaging examinations start with B-ultrasound, and the diagnostic value of intravenous pyelography is relatively small. CT scanning is the best way to understand the location, size, range, nature and metastasis of the tumor, so it has become the most reliable tool for diagnosing renal cancer. Smaller tumors generally do not require examinations of the cavity group and veins. If the patient has a larger right-sided tumor, caval angiography or MRI examination should be performed. MRI is now more commonly used to understand whether the tumor involves the vena cava and perform differential diagnosis. Cystoscopy should also be considered when there is hematuria. Renal artery angiography has a certain role in the diagnosis of renal cancer, especially selective or superselective renal artery embolization can be performed at the same time, which is conducive to the subsequent operation. Due to the possibility of needle tract implantation metastasis, the application value of Tru-cut puncture biopsy is controversial, but the development of fine needle cytology biopsy technology has greatly reduced the possibility of implantation metastasis.

1. X-ray: X-ray films and urography are of little value in diagnosing renal cancer, especially plain films, which have limited effect.

(1) Plain film: Larger renal cancers may show local protrusion of the kidney outline, and the outer edge of the kidney may be nodular. About 5-10% of renal cancers may show calcification, which is usually of low density and mostly appears as fine dots, occasionally in the shape of an arc.

(2) Intravenous urography: The findings of urography depend on the size and location of the renal tumor and the degree of invasion of the collecting system. When the tumor is small and limited to the parenchyma, urography may show no abnormal changes. As the lesion develops, the tumor will first push and compress the collecting system, causing deformation, stenosis, elongation, truncation, occlusion or displacement of the renal pelvis and calyx. When the tumor just begins to invade the collecting system, the contours of the renal pelvis and calyx may become irregular and rough. When the tumor grows into the renal pelvis and calyx, filling defects may occur. Tumors with diffuse infiltrative growth may present polycystic kidney-like changes, with irregular shapes of the renal pelvis and calyx, and may also cause loss of function of the affected kidney. They will not be visualized during imaging, and only irregular enlargement of the renal shadow will be shown. Huge tumors may cause deviation of the renal axis and may also compress and push the ureter. When the tumor protrudes toward the renal hilum or metastasizes to the renal hilar lymph nodes, the normally concave renal hilar shadow disappears.

(3) Retrograde upper urinary tract angiography: This examination is not very helpful in the diagnosis of renal cancer, but it can be used to differentiate kidneys that do not show up in intravenous urography from other upper urinary tract lesions.

2. Ultrasound: B-ultrasound examination is simple and easy to perform, and does not cause pain or trauma to the examinee. It has now become one of the main items for regular health checkups in many units. More and more asymptomatic renal cancers are discovered in this way. B-ultrasound has a high sensitivity in detecting kidney tumors and can be used as the preferred examination method. The mass-like echoes in the renal parenchyma are a direct sign of ultrasound diagnosis of renal cancer. However, it should also be noted that B-ultrasound images of renal cancer are non-specific, especially for tumors with a diameter of <2cm or atypical sonographic manifestations. Diagnosis is somewhat difficult and requires close combination with clinical and other examination results for comprehensive analysis and judgment. On B-ultrasound images, typical renal cancer may have the following manifestations:

(1) Changes in kidney contour: When the tumor is small, the kidney contour may not change significantly. Larger tumors protrude from the kidney surface, causing the kidney contour to increase in localized size and become uneven. The kidney shape loses its normal appearance. The boundary between the tumor and the surrounding tissue is relatively clear. However, when advanced renal cancer infiltrates the surrounding tissue extensively, the boundary is often unclear.

(2) Abnormal echo of renal parenchyma: Abnormal echo masses appear in the renal parenchyma, which are round or oval in shape, with clear boundaries and a sense of sphere. The internal echo varies. Most medium-sized tumors are low-echoic, and only a few are mixed echoes or equal echoes of varying strengths. When there is bleeding, necrosis or liquefaction inside a larger tumor, an irregularly edged anechoic area will appear locally. If there is calcification, it will appear as a point or block of strong echoes with acoustic shadows. Smaller renal cancers sometimes appear as high-echo masses.

(3) The echo of the renal sinus is compressed and deformed: When the tumor grows inward and compresses or invades the renal sinus, the renal sinus may become concave, displaced, interrupted, or even unclear. In a few cases, the renal pelvis and calyx may expand and accumulate water.

The above is some knowledge about kidney cancer diagnosis that we have prepared for you today. We hope it will be helpful to you. If you have any other needs, you can also consult our online consulting experts. We are always here to answer your questions and give you more detailed guidance.

Kidney cancer: http://www..com.cn/zhongliu/sa/